Uncommon Onset of Steroid-Induced Psychosis at Replacement Dose in Secondary Adrenal Insufficiency: A Case Study of Partial Empty Sella Syndrome

Manimozhi T, P. M. Karthik, Raja M, Aravind Mirajkar

Abstract: Steroid-induced psychosis is typically linked to high-dose glucocorticoid therapy, but in rare cases, it can emerge even with standard replacement doses, particularly in patients with chronic adrenal insufficiency. This article presents a compelling case of a 48-year-old female who developed acute psychotic symptoms after being initiated on a low-dose prednisolone regimen for secondary adrenal insufficiency associated with partial empty sella syndrome. Interestingly, her symptoms surfaced despite the dose being well below the threshold commonly reported in similar cases. In my view, this highlights a noteworthy clinical nuance: patients with long-standing glucocorticoid deficiency may exhibit heightened sensitivity to even minimal hormonal shifts. It is evident that the underlying chronic hypo-cortisolemic state may predispose such individuals to abrupt neuropsychiatric reactions when hormone levels are corrected. This case underscores the need for vigilant monitoring and early psychiatric intervention during initial glucocorticoid replacement therapy. Moreover, it suggests a broader clinical implication patients must be properly informed about potential side effects, even when doses appear physiologically benign.

Keywords: steroid-induced psychosis, adrenal insufficiency, prednisolone, empty sella syndrome, glucocorticoid replacement