Author/Authors :
Jolayemi, Ayodeji Interfaith Medical Center - Brooklyn - NY, USA , Jegede, Oluwole Interfaith Medical Center - Brooklyn - NY, USA , Gustave, Mario Interfaith Medical Center - Brooklyn - NY, USA , Jeyakumar, Ajouka American University of Antigua - Osbourn, Saint Kitts and Nevis , Balakumar, Thyarapan American University of Antigua - Osbourn, Saint Kitts and Nevis , Raghu, Alyssa American University of Antigua - Osbourn, Saint Kitts and Nevis , Soewono, Katarina American University of Antigua - Osbourn, Saint Kitts and Nevis , Chang, Katherine I. Medical University of the Americas - Charlestown, Saint Kitts and Nevis
Abstract :
We present a case of an incidental diagnosis of panhypopituitarism in a 68-year-old African American man admitted to ourpsychiatric inpatient unit with symptoms suggestive of schizophrenia. The case was unusual as a first-episode psychosis giventhe patient’s age. In the course of his admission, the patient’s clinical condition deteriorated culminating in a sudden altered mentalstatus which prompted a transfer to the medical floors and further investigations. A head CT scan and a pituitary MRI revealed anear total resection of the pituitary while laboratory investigations revealed hyponatremia and a grossly low hormone profile. Theprogression of these events casts doubts on our admitting diagnosis as the primary cause of the patient’s symptoms. The patient’sclinical condition improved only when his endocrinopathy was treated with hormone replacement, fluids, and electrolyte correctionin addition to antipsychotics. An inability to verify the patient’s psychiatric history and a remote history of pituitary resection severaldecades earlier, unknown to the treating team, added to the diagnostic conundrum. We revised the diagnosis to neuropsychiatricmanifestations secondary to an organic brain syndrome due to a partial pituitary resection. The patient was discharged with nosymptoms of psychosis, good insight, judgment, and good reality testing.
