Acute Psychosis and Panhypopituitarism: A Case Report

We present a case of acute psychosis in a patient with panhypopituitarism admitted for adrenal crisis secondary to insufficient glucocorticoid replacement. Three months prior, she was admitted for a similar episode of adrenal crisis and underwent intubation; however, at that time her mental status was normal with no reported episodes of delirium or psychosis. After extubation, she was found to have psychotic symptoms which waxed and waned and were vaguely responsive to antipsychotics. She was ultimately stabilized and discharged, only to return three months later after missing multiple doses of her prednisone. During her current presentation, she had a recurrence of her waxing and waning mental status, which was presumed to be an organic result of her prior hypotension and anoxia vs. a primary psychotic break. In retrospect, it was largely dependent upon whether she received her scheduled steroids. Once her adrenal crisis had passed her cognition improved with daily steroid replacement and antipsychotics were unnecessary.