First Psychotic Episode: Panhypopituitarism and Psychosis in a Female Patient
DOI:
https://doi.org/10.51338/rppsm.731Keywords:
Hypopituitarism, Psychotic DisordersAbstract
Endocrine and psychiatric disorders frequently overlap, and neuropsychiatric symptoms can be the primary manifestation of an underlying endocrinopathy. This case report describes a 69-year-old Caucasian female admitted to a psychiatry department with severe persecutory and mystical delusions, auditory-verbal and visual hallucinations, and alopecia. Further investigation revealed a psychotic disorder attributed to panhypopituitarism, secondary to poor adherence to hormone replacement therapy following a pituitary resection in 1990. Following treatment optimization, the patient showed remarkable clinical improvement and was discharged after 31 days. This case highlights that while psychosis is a rare presentation of panhypopituitarism, it is crucial to rule out treatable organic etiologies in patients presenting with acute psychiatric features, preventing diagnostic delays and ensuring appropriate targeted therapy.
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Nwokolo M, Fletcher J. A rare case of hypopituitarism with psychosis. Endocrinol Diabetes Metab Case Rep. 2013;2013:130007. doi: 10.1530/edm-13-0007. DOI: https://doi.org/10.1530/EDM-13-0007
Kate S, Dhanwal DK, Kumar S, Bharti P. Acute psychosis as a presentation of hypopituitarism. BMJ Case Rep. 2013;2013:bcr2012008516. doi: 10.1136/bcr-2012-008516. DOI: https://doi.org/10.1136/bcr-2012-008516
Snyder PJ. Clinical manifestations of hypopituitarism. Waltham: UpToDate; 2022 [cited 2026 May 20]. Available from: https://www.uptodate.com/contents/clinical-manifestations-of-hypopituitarism
Anglin RE, Rosebush PI, Mazurek MF. The neuropsychiatric profile of Addison's disease: revisiting a forgotten phenomenon. J Neuropsychiatry Clin Neurosci. 2006;18:450-9. doi: 10.1176/jnp.2006.18.4.450. DOI: https://doi.org/10.1176/jnp.2006.18.4.450
American Board of Internal Medicine. ABIM Laboratory Test Reference Ranges. Philadelphia: ABIM; 2024 [cited 2026 May 20]. Available from: https://www.abim.org
Alexander J. Panhypopituitarism and psychosis in a male patient. Aust N Z J Psychiatry. 2010;44:393-4. doi: 10.3109/00048671003614205. DOI: https://doi.org/10.3109/00048671003614205
Bulow B, Hagmar L, Orbaek P, Osterberg K, Erfurth EM. High incidence of mental disorders, reduced mental well-being and cognitive function in hypopituitary women with GH deficiency treated for pituitary disease. Clin Endocrinol. 2002;56:183-93. doi: 10.1046/j.0300-0664.2001.01461.x. DOI: https://doi.org/10.1046/j.0300-0664.2001.01461.x
Leigh H, Kramer SI. The psychiatric manifestations of endocrine disease. Adv Intern Med. 1984;29:413-45.
Nieman LK. Clinical manifestations of adrenal insufficiency in adults. Waltham: UpToDate; 2023 [cited 2026 May 20]. Available from: https://www.uptodate.com/contents/clinical-manifestations-of-adrenal-insufficiency-in-adults
Dissanayake SA, Leiberman DM, Heath D. Hypopituitarism with paranoid psychosis: a description of two cases. J Neurol Neurosurg Psychiatry. 1969;32:233-5. doi: 10.1136/jnnp.32.3.233. DOI: https://doi.org/10.1136/jnnp.32.3.233
Reus VI. Behavioral disturbances associated with endocrine disorders. Annu Rev Med. 1986;37:205-14. doi: 10.1146/annurev.me.37.020186.001225. DOI: https://doi.org/10.1146/annurev.me.37.020186.001225
Howard R, Rabins PV, Seeman MV, Jeste DV; International Late-Onset Schizophrenia Group. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. Am J Psychiatry. 2000;157:172-8. doi: 10.1176/appi.ajp.157.2.172. DOI: https://doi.org/10.1176/appi.ajp.157.2.172
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington: American Psychiatric Association Publishing; 2022. DOI: https://doi.org/10.1176/appi.books.9780890425787
