Differential mood response to natural and synthetic corticosteroids after bilateral adrenalectomy: a case report

A 48-year-old woman who had had a bilateral adrenalectomy for Cushing's syndrome developed severe psychotic symptoms that were unresponsive to psychotropic drugs as long as she was taking prednisone (PRED) as replacement therapy. However, after she was switched to a regimen of cortisol (CORT) and fludrocortone (FLUD) the psychopathology disappeared. Mechanisms related to the differences in the interaction of natural (e.g. CORT) and synthetic (e.g. PRED) corticosteroids with the central glucocorticoid and mineralocorticoid receptors may explain the different effects upon psychopathology.