Acute Psychosis Following Hydrocortisone Replacement in a Patient with Secondary Adrenal Insufficiency Due to Recurrent Postoperative Pituitary Macroadenoma
Amarta Shankar Chowdhury *
Department of Endocrinology, Gauhati Medical College, Guwahati, 781032, Assam, India.
Dipti Sarma
Department of Endocrinology, Gauhati Medical College, Guwahati, 781032, Assam, India
Uma Kaimal Saikia
Department of Endocrinology, Gauhati Medical College, Guwahati, 781032, Assam, India.
Bipul Kumar Choudhury
Department of Endocrinology, Gauhati Medical College, Guwahati, 781032, Assam, India.
Utpal Bora
Department of Psychiatry, Gauhati Medical College, Guwahati, 781032, Assam, India.
*Author to whom correspondence should be addressed.
Abstract
Acute psychosis in patients receiving physiological corticosteroid replacement is rare. The exact mechanism of this disorder is not clear. We report a case of a 50 year old female with recurrent post operative pituitary macroadenoma who had presented to us with features of adrenocortical insufficiency. The patient was started on intravenous (iv) hydrocortisone and after receiving six doses, she developed features of acute psychosis. She was put on anti-psychotics and hydrocortisone was withheld for 24 hrs. The patient recovered in a couple of days and oral hydrocortisone was re-started at 5 mg per/day and increased to 15 mg/day without recurrence of symptoms of psychosis.
Keywords: Acute psychosis, hydrocortisone replacement, adrenal insufficiency, hypopituitarism