Adrenal insufficiency presenting with psychosis

Area of Science:

• Endocrinology
• Neuropsychiatry

Background:

• Primary adrenal insufficiency (PAI) typically presents with nonspecific symptoms.
• Neuropsychiatric manifestations like psychosis and catatonia are rare in PAI and often misdiagnosed.

Purpose of the Study:

• To highlight the uncommon neuropsychiatric presentation of PAI.
• To emphasize the importance of recognizing subtle clinical signs for early diagnosis.

Main Methods:

• Case report of a young adult male with severe psychiatric symptoms.
• Clinical examination revealing hyperpigmentation, hypotension, and electrolyte imbalance.
• Endocrine testing confirming autoimmune PAI.

Main Results:

• The patient presented with hallucinations, delusions, and catatonia, alongside gastrointestinal issues and weight loss.
• Laboratory findings indicated hyponatremia and hyperkalemia.
• Hormone replacement therapy resulted in rapid improvement of both psychiatric and physical symptoms.

Conclusions:

• PAI should be considered in psychiatric presentations, especially when accompanied by physical signs like hyperpigmentation and weight loss.
• Prompt endocrine evaluation can prevent misdiagnosis and unnecessary investigations.
• Timely corticosteroid and mineralocorticoid replacement is crucial for managing PAI.