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

Introduction: Addison disease is a relatively uncommon endocrine disease resulting from adrenal insufficiency. Psychiatric symptoms are among its rare 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 with a history of immune thrombocytopenic purpura (ITP) and asthma since childhood presented with a 13-month history of progressive depression with insomnia and nightmare symptoms. After being prescribed haloperidol, clomipramine, and clonazepam for eight months, abdominal pain and weight loss due to anorexia started. Her physical examination showed skin hyperpigmentation in the elbow, knee, ankle, and buccal mucosa. Physical examination and initial laboratory tests suggested adrenal insufficiency. Addison disease was confirmed according to the laboratory 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.