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Addison crisis related psychosis

Published online by Cambridge University Press:  01 September 2022

A. Papanastasiou*
Affiliation:
SOTIRIA GENERAL UNIVERSITY HOSPITAL, Psychiatry, ATHENS, Greece
A. Roubi
Affiliation:
SOTIRIA GENERAL UNIVERSITY HOSPITAL, Psychiatry, ATHENS, Greece
L. Tsitrouli
Affiliation:
SOTIRIA GENERAL UNIVERSITY HOSPITAL, Psychiatry, ATHENS, Greece
A. Antoniou
Affiliation:
SOTIRIA GENERAL UNIVERSITY HOSPITAL, Psychiatry, ATHENS, Greece
G. Vouraki
Affiliation:
SOTIRIA GENERAL UNIVERSITY HOSPITAL, Psychiatry, ATHENS, Greece
E.T. Tsapardoni
Affiliation:
SOTIRIA GENERAL UNIVERSITY HOSPITAL, Psychiatry, ATHENS, Greece
V. Drakuli
Affiliation:
SOTIRIA GENERAL UNIVERSITY HOSPITAL, Psychiatry, ATHENS, Greece
S.M. Papageorgiou
Affiliation:
SOTIRIA GENERAL UNIVERSITY HOSPITAL, Psychiatry, ATHENS, Greece
A. Pahi
Affiliation:
SOTIRIA GENERAL UNIVERSITY HOSPITAL, Psychiatry, ATHENS, Greece
*
*Corresponding author.

Abstract

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Introduction

Addison’s disease (AD) is a rare disorder of the adrenal glands which causes deficiency of cortisol and aldosterone. It presents with a variety of symptoms, including neuropsychiatric manifestations. We discuss the case of a patient who exhibited psychotic symptoms in clear consciousness and no other clinical sign of AD.

Objectives

To investigate the association between AD and neuropsychiatric symptoms; to make clinicians aware of psychotic manifestations of AD as first presentation.

Methods

Case Presentation of a patient with psychosis and AD. A review of the literature was conducted in PubMed using the following keywords: Addison’s disease, Addison crisis, psychosis, psychotic, neuropsychiatric

Results

A 32-year-old alert male patient presented with delusions of persecution, auditory hallucinations and mild psychomotor agitation after a stressful life event. Lab tests showed hyponatremia (132 mEq/L). Patient exhibited rapid clouding of consciousness after admission and further lab results showed low levels of cortisol. He was therefore started treatment with high doses of hydrocortisone with good response. A close association between AD and psychiatric manifestations was indicated by the literature review, especially in males and those with thyroid dysfunction comorbidity. These include a wide range of symptoms, such as apathy, catatonia, anxiety, depression, lethargy, delirium, cognitive disorder, irritability, behavioural disorders, agitation, delusions, hallucinations, and rarely psychotic symptoms in clear consciousness. The aetiopathogenetic mechanism involves electrolyte disturbances, cortisole deficiency and increase in endogenous endorphines

Conclusions

Clinicians should be alert of the manifestation of AD with psychiatric symptoms ;patients with AD should be informed of the risk for Addison crisis after stress.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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