Steroid psychosis in an adrenal insufficiency and hypothyroidism patient

Acute psychosis after corticosteroid treatment is not unusual; however, the induction of psychosis by a low dose of corticosteroid is uncommon. We describe the case of a 77-year-old man who had adrenal insufficiency and Hashimoto's thyroiditis who, with previous corticosteroid exposure, developed insomnia, sexual hallucinations, aggression and exhibited self-harm behavior after the administration of cortisone 25 mg in the morning and 12.5 mg in the evening. These psychiatric symptoms improved when the corticosteroid therapy was discontinued, but recurred after re-administering 5 mg prednisolone per day. Agitation persisted even at a very low dose of prednisolone, namely 2.5 mg per day. He recovered after corticosteroid treatment was stopped.