A patient with psychosis following acute adrenal insufficiency: a case report

Abstract

Background: Psychiatric symptoms rarely emerge as primary signs and, particularly, as the sole signs of adrenal insufficiency. Instead, they are associated with chronic medical causes or as a result of medication the patients use. Despite these facts, most physicians, psychiatrists, and endocrinologists are unaware of the relationship between these disorders. In this, we present a patient who had both psychotic symptoms and an adrenal insufficiency diagnosis.

Case presentation: In the present report, we describe a 52-year-old Iranian woman with psychosis following adrenal insufficiency due to an abrupt discontinuation of corticosteroids. She was initially admitted due to loss of appetite, nausea, and vomiting with normal vital signs. The patient’s symptoms were: moon face, dry mucous membranes, Ecchymosis in different regions weak muscular force diarrhea. On the third day of her hospitalization, she was restless and aggressive. After further assessment; the medical team found out that she abruptly withdrew the use of dexamethasone (both oral and injection) and thereafter an acute adrenal insufficiency diagnosis was confirmed for her. Also, it was understood that the psychotic symptoms also emerged due to the abrupt discontinuation of Glucocorticoids.

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.