Adrenocorticotropic Hormone-Secreting Pituitary Microadenoma Presenting with Acute Psychosis, Delirium and Paroxysmal Sympathetic Hyperactivity – PubMed Black Hawk Supplements

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Adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas are known to be associated with behavioural changes but acute presentation including psychosis and delirium are less common. We report the case of a 42-year-old female patient with a known medical history of hypertension and diabetes mellitus, presenting with acute onset behavioural changes suggestive of psychosis to a tertiary care centre in Muscat, Oman in 2022. Further evaluation revealed an ACTH dependent Cushing’s disease with…
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Adrenocorticotropic Hormone-Secreting Pituitary Microadenoma Presenting with Acute Psychosis, Delirium and Paroxysmal Sympathetic Hyperactivity - PubMed

Case Reports

Adrenocorticotropic Hormone-Secreting Pituitary Microadenoma Presenting with Acute Psychosis, Delirium and Paroxysmal Sympathetic Hyperactivity

Neeraja Rajeev et al. Sultan Qaboos Univ Med J. 2024 Aug.

Abstract

Adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas are known to be associated with behavioural changes but acute presentation including psychosis and delirium are less common. We report the case of a 42-year-old female patient with a known medical history of hypertension and diabetes mellitus, presenting with acute onset behavioural changes suggestive of psychosis to a tertiary care centre in Muscat, Oman in 2022. Further evaluation revealed an ACTH dependent Cushing’s disease with a pituitary microadenoma. The patient was admitted for endoscopic resection of the adenoma. During the peri-operative period, she experienced worsening of psychosis in addition to delirium. She also developed episodes of unresponsiveness, posturing, severe diaphoresis and dyspnoea accompanied by tachycardia and hypertension which were managed with midazolam and levetiracetam. A seizure work-up and computed tomography brain scan were unremarkable. At follow-up, she showed full resolution of symptoms with good blood pressure and glycaemic control.

Keywords: Case Report; Cushing’s Disease; Dysautonomia; Neuropsychiatry; Oman.

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Figures

Figure 1
Figure 1

Pre-operative T1W magnetic resonance imaging scan with contrast in the (A) coronal and (B) sagittal view showing haemorrhagic pituitary microadenoma.

Figure 2
Figure 2

Tumour tissue consisting of groups and trabeculae of uniform cells with nuclear stippled chromatin, inconspicuous nucleoli and moderately abundant acidophilic cytoplasm using (A) haematoxylin and eosin stain at ×200 magnification; (B) the cells also show diffuse weak to moderate staining for adrenocorticotropic hormone using immunohistochemistry at ×200 magnification.

Figure 3
Figure 3

Post-operative T1W magnetic resonance imaging scan with contrast in the (A) coronal and (B) sagittal view showing no obvious residual.

References

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Adrenocorticotropic Hormone-Secreting Pituitary Microadenoma Presenting with Acute Psychosis, Delirium and Paroxysmal Sympathetic Hyperactivity – PubMed