Govind Pooja, Subramanian Karthick, Kumar Suriya
Department of Psychiatry, Mahatma Gandhi Medical College & Research Institute (MGMC&RI), Sri Balaji Vidyapeeth (Deemed to be University), Pondicherry, India.
Case Rep Psychiatry. 2022 Jun 1;2022:5056976. doi: 10.1155/2022/5056976. eCollection 2022.
Primary adrenal insufficiency rarely occurs due to infections, which consequently involves destruction or dysfunction of both adrenal cortices. Tuberculous adrenalitis is still a frequent cause of adrenal insufficiency in developing countries. We present the case of origin of multiple delusions along with recurrent spells of vomiting and giddiness in a patient with pulmonary tuberculosis (TB). A thorough medical history combined with a panel of biochemical and endocrine investigations revealed disseminated TB with choroid tubercles and adrenal infiltration leading to primary adrenal insufficiency. A diagnosis of organic delusional disorder secondary to disseminated TB-associated adrenal insufficiency was considered. The patient was managed with risperidone and antitubercular drugs. The psychosis improved and the patient was stable during the follow-up. The present case report adds to the literature on diagnostic challenges associated with psychosis due to adrenal insufficiency secondary to disseminated TB.
原发性肾上腺皮质功能减退症很少由感染引起，感染会导致双侧肾上腺皮质破坏或功能障碍。在发展中国家，结核性肾上腺炎仍是肾上腺皮质功能减退症的常见病因。我们报告了一例患有肺结核的患者出现多种妄想以及反复呕吐和头晕发作的病例。详细的病史结合一系列生化和内分泌检查显示，患者患有播散性结核病，伴有脉络膜结核结节和肾上腺浸润，导致原发性肾上腺皮质功能减退症。考虑诊断为播散性结核病相关肾上腺皮质功能减退继发的器质性妄想障碍。该患者接受了利培酮和抗结核药物治疗。精神病症状有所改善，患者在随访期间病情稳定。本病例报告为因播散性结核病继发肾上腺皮质功能减退所致精神病的诊断挑战增添了文献资料。
