title: Psychiatric symptoms in a patient with isolated adrenocorticotropin deficiency: case report and literature review.
abstract: We report a 59-year-old man with isolated adrenocorticotropin (ACTH) deficiency. The patient presented with sudden onset of delusions and hallucinations at the age of 54, which resolved gradually without treatment. Subsequently, the patient manifested stereotypy, wandering, hypobulia, and autistic symptoms, and was treated with antipsychotics for 1 year without any improvement. He suffered from neuroleptic malignant syndrome-like symptoms at the age of 59. A thorough endocrine assessment revealed isolated ACTH deficiency. After hydrocortisone supplementation, the physical and psychiatric symptoms improved dramatically. Clinicians should consider this rare disease when diagnosing patients with refractory psychiatric symptoms and unique physical symptoms of isolated ACTH deficiency.
authors.affiliation: Department of Psychiatry, The University of Tokushima School of Medicine, Tokushima 770-8503, Japan. Electronic address: muchinofu@hotmail.com.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Morigaki
authors.affiliation: Department of Psychiatry, The University of Tokushima School of Medicine, Tokushima 770-8503, Japan.
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Iga
authors.affiliation: Department of Psychiatry, The University of Tokushima School of Medicine, Tokushima 770-8503, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Kameoka
authors.affiliation: Department of Psychiatry, The University of Tokushima School of Medicine, Tokushima 770-8503, Japan.
authors.forename: Satsuki
authors.initials: S
authors.lastname: Sumitani
authors.affiliation: Department of Psychiatry, The University of Tokushima School of Medicine, Tokushima 770-8503, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ohmori
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000172:deficiency*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology*; D004700:Endocrine System Diseases / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D030342:Genetic Diseases, Inborn / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000494:pharmacology*; D007003:Hypoglycemia / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis; D011618:Psychotic Disorders / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: ACTH deficiency; Depression; Isolated; Neuroleptic malignant syndrome; Organic mental disorders; Psychotic disorders