Psychotic Disorder as the First Manifestation of Addison Disease: A Case Report

Abstract

Introduction: Addison disease (AD) is a relatively uncommon endocrine disease resulting from adrenal insufficiency. Psychiatric symptoms are rare and observed as AD’s primary and particularly isolated clinical symptoms. This report presents a case with adrenal insufficiency manifested by the psychotic syndrome. Case Presentation: A 28-year-old Iranian female teacher with a history of immune thrombocytopenic purpura (ITP) and asthma since childhood presented 13 months history of progressive depression with insomnia and nightmare symptoms. After being prescribed haloperidol, clomipramine, and clonazepam for eight months, the patient started abdominal pain and weight loss due to anorexia. Her physical exam showed skin hyperpigmentation in the elbow, knee, ankle, and in the mouth buccal mucosa. Physical examination and initial lab tests suggested adrenal insufficiency. Addison disease was confirmed according to the lab tests and abdominal CT. The symptoms were significantly improved using intravenous hydrocortisone treatment. The patient remained calm and had a normal sleep without depressive symptoms or psychosis after 72 hours of treatment. During one year of follow-up, the patient was in good general condition without psychological symptoms. Conclusions: This report shows that psychotic disorder can be the first manifestation of Addison disease. Therefore, physicians should be informed about the neuropsychiatric symptoms of adrenal insufficiency, especially when the patient lacks a family or personal history of psychiatric illness.