Adrenal Psychosis, A Diagnostic Challenge

Abstract

The purpose of this case discussion is to improve awareness of physicians to the fact that inadequate production of cortisol could produce psychosis. Psychosis or psychiatry disorders could be a presentation of a defect in cortisol production due to a problem with the hypothalamic-pituitary-adrenal axis and organic psychosis. In patients with recurrent psychiatric hospital admissions and failure of multiple antidepressants, it may be prudent to revisit organic causes of psychosis. Though more studies need to be done, the author want a discussion on this topic to improve awareness of physicians about this possibility before starting or adding psychotropic medications in view of the potential side effects associated with these medications.

Stress, Schizophrenia and Bipolar Disorder

“…The biological mechanisms of elevated cortisol levels in schizophrenia and bipolar disorder may be associated with the predisposition to psychosis, environmental effects or an interaction of the two (Wang et al 2011;Aina 2013;Perroud et al 2011). Predisposing genetic factors may include common variants on single nucleotide polymorphisms (SNPs) in genes associated with cortisol metabolism (SRD5A2) (Steen et al 2010), the regulation of cortisol (glucocorticoid receptor, NR3C1) (Schatzberg et al 2014), dopamine catabolism (catechol-omethyltransfease COMT; dopamine D4 receptor gene (DRD4) (Jabbi et al 2007), inhibitory neurotransmittors (GABA a6 receptor subunit gene; GABRA6) (Uhart et al 2004) and stress-vulnerability (serotonin transporter-linked polymorphic region; 5-HTTLPR) (Miller et al 2013).…”

“…Similarly, environmental factors such as substance abuse (Lopez-Larson et al 2011;Gavrieli et al 2011), sleep deprivation (Spiegel et al 1999), dietary changes (Cheng and Li 2012), lower socioeconomic status (Rudolph et al 2014) and a lower level of education (Karlamangla et al 2013) may contribute to the increased cortisol. While it remains unclear whether elevated cortisol levels are a risk factor for these disorders or a consequence of onset, recent studies suggest that it may be an interaction of the two (Wang et al 2011;Aina 2013;Perroud et al 2011).…”

Acute psychotic episode inaugurating a primary hyperaldosteronism: a case report

“…Major depressive disorders were observed in 50-70% of cases, anxiety disorders in 12-79% of cases, and hypomania in 3% [ 6 ]. We illustrate the complexity and interactions between adrenal adenoma and psychotic symptoms through a clinical case of a patient with portico-adrenal adenocarcinoma [ 7 ].…”