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Case Reports in Psychiatry
Volume 2015 (2015), Article ID 512430, 4 pages
Case Report

Severe Psychotic Disorder as the Main Manifestation of Adrenal Insufficiency

1Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
2Hospital 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

Received 29 December 2014; Accepted 8 March 2015

Academic Editor: Erik Jönsson

Copyright © 2015 Julia de Lima Farah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.