by David R. Spiegel, MD, FAPA; Aaron B. Nelson, MD; David C. Lieb, MD, FACE, FACP; Alexander M. Pattison, MD; Justin Smith, DO; Patrice Zigrossi, MD; and Erin Godbout, MD

Dr. Spiegel, Dr. Pattison, Dr. Smith, Dr. Zigrossi, and Dr. Godbout are with the Eastern Virginia Medical School, Department of Psychiatry and Behavioral Sciences in Norfolk, Virginia. Dr. Nelson and Dr. Lieb are with with the Eastern Virginia Medical School, Division of Endocrinology and Metabolism in Norfolk, Virginia.

Funding: The authors report no sources of financial support in presentation of this manuscript.

Financial Disclosures: None

Abstract: Adrenal insufficiency is divided into three types based on the etiology of its development. In primary adrenal insufficiency, pathology resides in end-organ failure at the level of the adrenal cortex, while in secondary and tertiary adrenal insufficiency, impairment rests in the pituitary gland and hypothalamus, respectively. Regardless of etiology, adrenal insufficiency results in a hypocortisolemic condition. While the relationship between neuropsychiatric symptoms, especially psychosis, and hypercortisolemia has been extensively documented, the development of hypocortisolemia-induced psychosis is less common. We present a case of secondary adrenal insufficiency caused by a pituitary tumor. During the course of evaluation and treatment, the patient developed a psychotic episode. We will briefly review the condition of adrenal insufficiency and propose how hypocortisolemia can result in psychosis.

Keywords: Psychosis, secondary adrenal insufficiency, hypocortisolemia, proinflammatory cytokines

Innov Clin Neurosci. 2017;14(9–10):4–10



Category: Case Report, Medical Issues, Past Articles, Psychosis