Hypercortisolemia and acute psychotic disorder: a case report
Date |
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2020-09-12 |
no. P.843
Session title: ePoster Area – open 24/7. Session type:ePoster Session. Topics: Psychotic disorders Pharmacological interventions.
Supplement to the journal European Neuropsychopharmacology 1 December 2020.
Bibliogr.: p. 1
Background: The hypothalamic–pituitary–adrenal (HPA) axis plays an essential role in the pathogenesis of psychiatric disorders [1]. Changes in HPA axis function is mainly associated depression, also has been implicated in the pathophysiology of bipolar affective disorder, schizophrenia and post-traumatic stress disorder [1]. Cushing’s disease (CD) is a rare disorder, which results from chronic exposure to cortisol excess caused by a tumor of the pituitary gland. In CD, hypercortisolemia predisposes to mainly mood disorders, anxiety, sleep disturbance and cognitive decline. Psychosis is a rare manifestation of CD [2]. Case reports indicate the remission of psychosis in CD after correction of the endogenous hypercortisolemia. Nevertheless, after hypercortisolemia has been resolved, some patients report residual psychiatric symptoms, mainly cognitive disturbances [3]. The case description: In this case report we present the 34-year old female patient with non-typical organic psychosis. Patient with cushingoid appearance, severe hypercortisolemia and MRI-confirmed adenoma of hypophysis was diagnosed with CD 6 years ago. Patient first presented with psychotic symptoms after the second tumor removal surgery, three years after initial diagnosis. Blood test demonstrated elevated levels of cortisol (1044.56 nmol/L). Subsequently, she was treated with selective dopamine D2 and D3 receptor antagonist (tiapride titrated to 300 mg daily dose) for the psychotic symptoms and agitation in conjunction with adrenal steroid synthesis inhibitor metyrapone 3000 mg daily dose, following reduction of blood cortisol level to 346 nmol/L. However, patient remained psychotic and was hospitalized to psychiatric department. Patient was anxious, confused, expressed the feelings that world is changed, that the department looks like a theatre and all the patients, staff members are actors and trying to send her the special message. Des[...].