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Hypoadrenalism presenting as a range of mental disorders
Aleksandar Pavlovic1, Velusamy Sivakumar
1Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK. dralex@doctors.org.uk
BMJ Case Reports
|June 19, 2012
Summary
A hip replacement triggered primary adrenal insufficiency and hyponatremia, causing complex psychopathology including delusions and depression. Treatment with hormone replacement normalized mood and cognition, resolving psychiatric symptoms.
Area of Science:
- Endocrinology
- Psychiatry
- Geriatrics
Background:
- Complex psychopathology can arise from the interplay of trauma, endocrine disorders, and infection.
- Elderly patients, especially after surgery, may present with atypical psychiatric symptoms.
Observation:
- An 82-year-old woman developed fluctuating cognitive impairment, delusions, and severe depression post-hip replacement, associated with hyponatremia.
- Recurrent urinary tract infections (UTIs) coincided with persistent hyponatremia and psychiatric symptoms.
- Primary adrenal insufficiency was diagnosed via Synacthen test due to declining cortisol levels.
Findings:
- Treatment with lifelong hormone substitution normalized serum sodium, improved mood, cognition, and resolved psychotic features.
- The patient's psychopathology was hypothesized to be induced by hypoadrenalism, potentially triggered by hip surgery and exacerbated by UTIs.
- While hyponatremia is known to cause delirium, its association with affective disorders in this context is rare.
Implications:
- Highlights the importance of considering endocrine disorders, particularly adrenal insufficiency, in elderly patients with unexplained psychiatric symptoms post-surgery.
- Suggests a potential link between surgical trauma, hypoadrenalism, recurrent infections, and complex psychopathology.
- Underscores the need for comprehensive diagnostic workups in geriatric psychiatric cases to identify underlying medical conditions.
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