title: Atypical hypocortisolism.
abstract: OBJECTIVE
  To report a patient who had developed reversible hypocortisolism during the use of quetiapine.
  
  
  METHODS
  Early morning cortisol levels were measured on two separate days. In addition, the patient underwent testing with intravenous synthetic adrenocorticotropic hormone (1 mcg tetracosactide) before and after tapering of quetiapine. Pituitary function was assessed and magnetic resonance imaging (MRI) was performed.
  
  
  RESULTS
  The patient had low early morning cortisol levels at presentation when using quetiapine. Tetracosactide testing indicated hypocortisolism. A MRI of the pituitary was unremarkable. The patient was treated temporarily with hydrocortisone and quetiapine was tapered. After quetiapine had been discontinued, the patient's cortisol production had returned to normal.
  
  
  CONCLUSIONS
  Although lowering cortisol levels has been previously reported, this is the first report of hypocortisolism associated with the use of quetiapine. It is possible symptoms of malaise in patients who use quetiapine could be attributed to quetiapine-related hypocortisolism.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands Section of Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Koen M A
authors.initials: KM
authors.lastname: Dreijerink
authors.forename: Linda M
authors.initials: LM
authors.lastname: Kampschreur
authors.forename: Eef G W M
authors.initials: EG
authors.lastname: Lentjes
authors.forename: Bianca
authors.initials: B
authors.lastname: Lokhorst
authors.forename: Pierre M J
authors.initials: PM
authors.lastname: Zelissen
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003366:Cosyntropin / Q000494:pharmacology; D003987:Dibenzothiazepines / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D010902:Pituitary Gland / Q000187:drug effects; D000069348:Quetiapine Fumarate
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D003366:Cosyntropin; D000069348:Quetiapine Fumarate; D006854:Hydrocortisone