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Presentación de caso
Psicosis después de insuficiencia suprarrenal aguda
Psicosis tras insuficiencia suprarrenal aguda
Zeinab Jalambadani1
Ali Taj2
Mohammad Reza Shegarf Nakhaie 3
1 Centro de Investigación de Enfermedades No Transmisibles, Facultad de Medicina, Universidad de Ciencias Médicas de Sabzevar, Sabzevar,
Irán
2 Escuela de Paramedicina, Centro de Investigación de Enfermedades No Transmisibles, Universidad de Ciencias Médicas de Sabzevar,
Sabzevar, Irán
3 Universidad de Ciencias Médicas de Sabzevar, Sabzevar, Irán
Recibido: 28/06/2025
Aceptado: 10/09/2025
Psicosis después de insuficiencia suprarrenal aguda
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Abstracto
Introducción: Los síntomas psiquiátricos rara vez surgen como signos primarios y, particularmente, como el único
signos de insuficiencia suprarrenal. En cambio, están asociados con causas médicas crónicas o como un
resultado de la medicación que usan los pacientes. A pesar de estos hechos, la mayoría de los médicos, psiquiatras y
Los endocrinólogos desconocen la relación entre estos trastornos. En este, presentamos un
paciente que tenía síntomas psicóticos y un diagnóstico de insuficiencia suprarrenal.
Presentación del caso: En el presente informe, describimos a una mujer iraní de 52 años con psicosis
después de una insuficiencia suprarrenal debido a una interrupción abrupta de los corticosteroides. Ella fue
Inicialmente ingresado por pérdida de apetito, náuseas y vómitos con signos vitales normales. El
patienLos síntomas de t fueron: cara de luna, membranas mucosas secas, equimosis en diferentes regiones
diarrea de fuerza muscular débil. Al tercer día de su hospitalización, estaba inquieta y
agresivo. Después de una evaluación adicional; El equipo médico descubrió que retiró abruptamente el
uso de dexametasona (tanto oral como inyectable) y, posteriormente, una insuficiencia suprarrenal aguda
Se confirmó el diagnóstico para ella. Además, se entendió que los síntomas psicóticos también
surgió debido a la interrupción abrupta de los glucocorticoides.
Conclusiones: La interrupción abrupta de los glucocorticoides en los pacientes puede provocar un trastorno suprarrenal agudo
insuficiencia, que muestra síntomas como edema, cara de luna, membranas mucosas secas y
síntomas gastrointestinales. Pero también se puede ver junto con síntomas psicóticos, que es un
efecto secundario de la interrupción abrupta de los glucocorticoides.
Palabras clave: psicosis, insuficiencia suprarrenal, enfermería, medicina interna
Resumen
EnTroducción: los síntomas psiquiátricos rara vez se presentan como signos primarios y, en
particular, como los únicos signos de insuficiencia suprarrenal. Más bien, están asociados
con causas médicas crónicas o como resultado de la medicación que los pacientes utilizan.
A pesar de estos hechos, la mayoría de los médicos, psiquiatras y endocrinólogos desconocen
la relación entre estos trastornos. En este informe, presentamos un paciente que presentó
tanto síntomas psicóticos como diagnóstico de insuficiencia suprarrenal.
Presentación caso: en el presente informe, describimos a una mujer iraní de 52 años con
psicosis tras insuficiencia suprarrenal debido a una interrupción abrupta de corticosteroides.
Inicialmente fue ingresada por pérdida de apetito, náuseas y vómitos con signos vitales
normales. Los síntomas de la paciente fueron: cara de luna, mucosas secas, equimosis en
diferentes regiones, debilidad muscular y diarrea. En el tercer día de hospitalización, estuvo
Psicosis después de insuficiencia suprarrenal aguda
Rev. Hosp. Psiq. Hab. Volumen 22 | Año 2025 | Publicación continua
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inquieta y agresiva. Tras una evaluación más profunda, el equipo médico descubrió que había
interrumpido abruptamente el uso de dexametasona (tanto oral como inyectable) y
posteriormente se confirmó el diagnóstico de insuficiencia suprarrenal aguda. Además, se
entendió que los síntomas psicóticos también surgieron debido a la interrupción abrupta de
glucocorticoides.
Conclusiones: la interrupción abrupta de glucocorticoides en pacientes puede llevar a
insuficiencia suprarrenal aguda, manifestándose con síntomas como edema, cara de luna,
mucosas secas y síntomas gastrointestinales. Sin embargo, también puede presentarse junto
a síntomas psicóticos, los cuales son un efecto secundario de la discontinuación abrupta de
glucocorticoides.
Palabras clave: psicosis, insuficiencia suprarrenal, enfermería, medicina interna
Introducción
Los síntomas psiquiátricos rara vez surgen como signos primarios y, en particular, como los únicos signos de suprarrenales
insuficiencia. En cambio, se asocian con síntomas importantes en la mayoría de los casos; y la aparición
de los síntomas psiquiátricos expresa la gravedad de la enfermedad. A pesar de estos hechos, la mayoría de los médicos,
Los psiquiatras y endocrinólogos desconocen la relación entre estos trastornos y
El error más frecuente en el diagnóstico de la insuficiencia suprarrenal se produce cuando la presentación de la
La enfermedad refleja síntomas psiquiátricos y digestivos. Por otro lado, la prevalencia del yo-
La medicación con corticosteroides es alta en algunas regiones, donde su retirada abrupta puede conducir a
insuficiencia suprarrenal aguda y aparición de síntomas psiquiátricos, que se asocian con
diagnóstico tardío y menos notado. En el presente informe, describimos un caso de psicosis causada por
insuficiencia suprarrenal después de la interrupción repentina de los corticosteroides. En este, presentamos un
paciente que tenía síntomas psicóticos y un diagnóstico de insuficiencia suprarrenal.
Presentación del caso
La paciente era una mujer iraní de 52 años ingresada por pérdida de apetito, náuseas y vómitos.
y fue hospitalizado en el servicio interno por no responder a las terapias ambulatorias. Sobre
Al ingreso, los signos vitales aparecieron de la siguiente manera:
Presión arterial: 130/50 mmHg
Frecuencia del pulso: 85 por minuto
Frecuencia respiratoria: 16 por minuto
temperatura corporal: 36,5 °C
Psychosis following Acute Adrenal Insufficiency
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Upon physical examination, moon face, dry mucous membranes, and Ecchymosis in different
regions were detected. The patient's muscular force was 3/5, and she gradually lost her motion.
The patient got diarrhea and was unable to control stool (feces).
On the third day of her hospitalization, she was restless and aggressive and did not sleep overnight.
She removed her urine and Intravenous catheters and was unable to tolerate being bedridden. She
imagined an explosive mine under her bed, which she perceived, to explode soon. A history of
hypertension and diabetes was also reported. The results of laboratory tests were as follows: white
blood cell count =5900, red blood cell count =5.46, hemoglobin =126 g/L, hematocrit =41.6,
Na+=133, K=4.3, and creatinine =0.4 mg/dL. +
Psychiatric consultation was requested, where persecutory delusion was confirmed but
hallucination was not found. Orientation with time, place, and individuals was normal.
After frequent follow-ups and telephone calls, one of her relatives finally agreed to be interviewed
in the hospital. The relative denied a history of serious psychiatric disorders in the patient but
revealed that she had long been dependent on dexamethasone (both oral and injection) which she
abruptly withdrew two weeks ago by the recommendation of some other relatives.
Therefore, an immediate diagnosis of acute adrenal insufficiency due to abrupt withdrawal of
corticosteroid was made, and treatment started with prednisolone 10 mg b.i.d. Nausea and vomiting
stopped after the first two doses. The patient relaxed, then psychotic symptoms relieved on the
second day, and she was discharged from the hospital for gradual withdrawal of the medicine.
Discussion
One of the relatively uncommon complications related to adrenal glands (a pair of glands placed
above the kidneys) is adrenal insufficiency which comes in three forms (primary, secondary, and
tertiary) with distinct pathologies and treatment follow-ups (1, 2) The unspecific symptoms behind
adrenal insufficiency often lead to challenges in the diagnosing process.(3)
In a study by Bleicken et al., out of 216 patients with primary or secondary adrenal insufficiency,
less than 30 % of women and less than 50 % of men were diagnosed during the first six months
after the emergence of symptoms; 20% of them suffered from the symptoms five years before the
diagnosis; more than 67 % of them had already consulted with at least 3 physicians, and 68 % were
misdiagnosed.(4)
The cardinal symptoms of this disease include fatigue, lethargy, lack of appetite, nausea, vomiting,
constipation, abdominal pain, myalgia, arthralgia, flexion contracture in rare cases, maxillary and
Psychosis following Acute Adrenal Insufficiency
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pubis hair thinning, salt craving, orthostatic hypotension, and hyperpigmentation of the skin (in the
primary adrenal insufficiency).(5-7)
The psychiatric symptoms of Addison's disease (primary adrenal insufficiency) were characterized
for the first time in 1899 by Kipple, and were recognized as Addisonian encephalopathy; however,
the relationship is still not given due attention.(4, 8) Anglin et al. published four case reports in the
1940s and 1950s and found a 64 % to 85 % prevalence rate of neuropsychiatric symptoms in
patients with adrenal insufficiency. Similarly, Iwata et al. expressed that neuropsychiatric
symptoms were likely to emerge as the first symptoms of adrenal insufficiency.(9)
Neuropsychiatric symptoms include (depression, irritability, sleep disorders, apathy, cognitive
damage, delusion, and hallucination). Also, symptoms such as confusion, confabulation, irrelevant
talk, and slow thinking (reduced processing speed) are reported in acute adrenal insufficiency.(10)
Depression is the most common symptom associated with adrenal insufficiency and emerges
together with mild mood symptoms, demotivation, and behavior changes. However, psychosis,
mania, delirium, catatonia, and disorders of memory and orientation are less noticeable. Psychosis
is mainly seen with Addisonian crisis and the severe type of the disease. (4, 7)
Addisonian crisis is a life-threatening condition and a severe medical emergency by itself; such
patients suffer from severe hypotension, hyponatremia, fever, psychosis, delirium, and even coma.
Other symptoms such as agitation, delirium as well as audio-visual hallucinations are reported in
ome patients with adrenal insufficiency crisis.(9) Altogether, psychotic symptoms are reported from
4 % to 8 % in case series.(7)
Laboratory tests revealed electrolyte disorders such as hyponatremia due to inappropriate ADH
secretion (which occurs because of decreased glucocorticoid), hyperkalemia, mild hypercalcemia,
hyperchloremia, and metabolic acidosis, azotemia, mild normocytic anemia, lymphocytosis, and
mild eosinophilia; also, hypoglycemia occurs after long starvation.(7)
Causes of adrenal insufficiency are numerous, including autoimmune diseases and infectious
diseases such as tuberculosis.(7, 9) Corticosteroids are highly protein-bound hormones produced by
adrenal glands. The formulations of corticosteroids are accessible in diverse forms, including oral,
intravenous, intramuscular, aerosol, intra-articular, and topical. (11) Furthermore, they are
prescribed for various medical conditions (acute and chronic) and illnesses in different doses.(11, 12)
As for side effects, corticosteroids could cause adrenal insufficiency and psychiatric behaviors such
as insomnia, mood swings, paranoia, depression, depersonalization, and psychosis (in severe
cases).(11-13)
Psychosis following Acute Adrenal Insufficiency
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The risk of adrenal insufficiency is present in all patients who take corticosteroids 14. Gradual
reduction of doses prescribed over time can release the inhibition on the hypothalamic-pituitary-
adrenal (HPA) axis so that they can gain back their function, (11) Abrupt withdrawal of
corticosteroids, hemorrhage, and adrenal infarcts can also lead to acute Addison's syndrome .(7, 9)
The global prevalence rate of self-medication ranges from 0.2 to 3 %. In Iran, medications taken
without prescription amount to 10 to 15 %, and self-medication with steroids is not an exception.
From 2005 to 2010, medication with corticosteroids has risen from 13% to 23 % in Iran. In addition
to their side effects, their abrupt withdrawal is associated with complications such as acute adrenal
insufficiency which is likely to lead to serious symptoms in patients 6.
The causes of psychiatric symptoms behind adrenal insufficiency are unknown, but some
probabilities are noted, such as hyponatremia leading to brain swelling and lowered consciousness,
memory loss, and slow thinking. In addition, glucocorticoid receptors are located in the brain,
particularly in thehippocampus. The consequences of lowered stimulation of these receptors are
associated with memory impairment, and frontal circuit dysfunction,problems in executive
function, speed of brain processes, reasoning, and thinking. Proopiomelanocortin, on the other
hand, is a frontal hypophysis hormone that is abundantly produced if glucocorticoid stimulation is
reduced; this leads to a rise in endorphin production which causes psychotic symptoms and
hallucinations 4.
Henkin believed that glucocorticoid reduction led to neural irritability and increased capacity to
receive sensory stimuli and, in turn, led to auditory hallucination 9. In most cases, physical and
psychiatric symptoms fade away in less than a week after corticosteroid treatment 7. In our patient,
symptoms all faded away two days after the treatment onset. Psychiatrists need to consider medical
causes such as adrenal insufficiency in the face of patients with acute psychosis with no prior
history of psychiatric disorders, and pay special attention to medication history, particularly in
regions where taking glucocorticoids is common for cultural reasons, e.g., for weight gain.
Conclusions
The abrupt discontinuation of glucocorticoids in patients can lead to acute adrenal insufficiency,
demonstrating symptoms like edema, moon face, dry mucous membranes, and gastrointestinal
symptoms. But it also can be seen alongside with psychotic symptoms which is a side-effect of
abrupt discontinuation of glucocorticoids.
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Psychosis following Acute Adrenal Insufficiency
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Conflict of interest
I declare that I have no conflicts of interest in the publication of this article.
Authors Contribution Statement
M.Sh. presented the information related to the case. A.T. and Z.J. drafted the manuscript. All
authors revised and re-checked the manuscript.
