title: Severe psychotic disorder as the main manifestation of adrenal insufficiency.
abstract: We describe a case of severe psychotic disorder as the only manifestation of primary adrenal insufficiency. A 63-year-old man presented with psychotic symptoms without any prior psychiatric history. During the clinical and laboratorial investigation, exams revealed a normovolemic hyponatremia. The patient showed no other clinical signs or symptoms compatible with adrenal insufficiency but displayed very high ACTH and low serum cortisol concentrations. Brain magnetic resonance imaging showed no significant changes, including the pituitary gland. The patient was initially treated with intravenous corticosteroids, resulting in rapid remission of the psychotic symptoms. The association between adrenal insufficiency and neuropsychiatric symptoms is rare but these symptoms can often be the first clinical presentation of the disease.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil.
authors.forename: Julia de Lima
authors.initials: Jde L
authors.lastname: Farah
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil.
authors.forename: Carolina Villar
authors.initials: CV
authors.lastname: Lauand
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil.
authors.forename: Lucas
authors.initials: L
authors.lastname: Chequi
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fortunato
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Pasqualino
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil.
authors.forename: Luis Henrique
authors.initials: LH
authors.lastname: Bignotto
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Institute of Psychiatry, Dr. Ovidio Pires de Campos, 785-1 Andar, Ala Sul, Sala Chefias Médicas, 05403-010 São Paulo, SP, Brazil.
authors.forename: Rafael Loch
authors.initials: RL
authors.lastname: Batista
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil ; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Institute of Psychiatry, Dr. Ovidio Pires de Campos, 785-1 Andar, Ala Sul, Sala Chefias Médicas, 05403-010 São Paulo, SP, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Aprahamian