A Rare Presentation of Catatonia due to Primary Adrenal Insufficiency

Acute Mania and Psychosis in the Context of Primary Adrenal Insufficiency: A Systematic Review of the Literature

“…Forty-two studies remained after duplicates were removed. Following screening with respect to our inclusion and exclusion criteria, nine studies remained (Abdulla, 2021; Anglin et al, 2006; Farah et al, 2015; Grover et al, 2012; Harper and Earnshaw, 1970; Lever and Stansfeld, 1983; Mattsson, 1974; Munawar et al, 2019; Puzanov et al, 2019). N.J.B.…”

“…In all nine patients, management of adrenal insufficiency (Table 4) was attempted with steroids, often involving the combination of hydrocortisone and fluorohydrocortisone (ie, fludrocortisone). Steroid management led to the resolution of at least one major symptom category in 77.8% of the patients (n = 7) (Abdulla 2021; Anglin et al, 2006; Farah et al, 2015; Harper and Earnshaw, 1970; Mattsson, 1974; Munawar et al, 2019; Puzanov et al, 2019). In addition to hydrocortisone and fluorohydrocortisone, the resolution of persistent catatonic symptoms was attributed to electroconvulsive therapy (ECT) in one patient (Grover et al, 2012).…”

“…Antipsychotics (ie, chlorpromazine [n = 2], haloperidol [n = 1], amisulpride [n = 1], and unspecified [n = 1]) were administered in 55.6% of the cases (n = 5), yielding marginal to no improvement of psychiatric symptoms in 80% of these cases (n = 4) (Farah et al, 2015; Grover et al, 2012; Harper and Earnshaw, 1970; Lever and Stansfeld 1983). Benzodiazepines (ie, lorazepam [n = 2] and clopoxid [n = 1]) were administered in 33.3% of the cases (n = 3), including two cases of catatonia (n = 2), yielding no improvement of psychiatric symptoms (Grover et al, 2012; Mattsson, 1974; Puzanov et al, 2019). Additionally, a stimulant, methylphenidate, was administered in one case of catatonia (a trial for akinetic mutism vs catatonia) without symptom resolution (Puzanov et al, 2019).…”

Acute Mania in a Patient With Primary Adrenal Insufficiency Due to Autoimmune Adrenalitis: A Case Report

“…Interestingly, her symptoms did not improve following first-line treatment with IV lorazepam for catatonia, but she did improve following treatment with methylphenidate and hydrocortisone. It was suspected that the resolution of the patient’s catatonia was mostly associated with the corticosteroid treatment (as the patient continued to demonstrate significant improvement over the week before her discharge after discontinuation of methylphenidate) 16…”

“…It was suspected that the resolution of the patient's catatonia was mostly associated with the corticosteroid treatment (as the patient continued to demonstrate significant improvement over the week before her discharge after discontinuation of methylphenidate). 16 Although they are tentative, several theories have been proposed to explain the relationship between psychiatric symptoms and PAI. First, it is possible that hyponatremia-induced swelling of the brain could yield a myriad of neurologic disorders related to consciousness and cognition.…”