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Neuropsychiatric Manifestations in a Patient with Panhypopituitarism

We present a case of an incidental diagnosis of panhypopituitarism in a 68-year-old African American man admitted to our psychiatric inpatient unit with symptoms suggestive of schizophrenia. The case was unusual as a first-episode psychosis given the patient's age. In the course of his admissio...

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Autores principales: Jegede, Oluwole, Jeyakumar, Ajouka, Balakumar, Thyarapan, Raghu, Alyssa, Chang, Katherine I., Soewono, Katarina, Gustave, Mario, Jolayemi, Ayodeji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439068/
https://www.ncbi.nlm.nih.gov/pubmed/28567321
http://dx.doi.org/10.1155/2017/5082687
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author Jegede, Oluwole
Jeyakumar, Ajouka
Balakumar, Thyarapan
Raghu, Alyssa
Chang, Katherine I.
Soewono, Katarina
Gustave, Mario
Jolayemi, Ayodeji
author_facet Jegede, Oluwole
Jeyakumar, Ajouka
Balakumar, Thyarapan
Raghu, Alyssa
Chang, Katherine I.
Soewono, Katarina
Gustave, Mario
Jolayemi, Ayodeji
author_sort Jegede, Oluwole
collection PubMed
description We present a case of an incidental diagnosis of panhypopituitarism in a 68-year-old African American man admitted to our psychiatric inpatient unit with symptoms suggestive of schizophrenia. The case was unusual as a first-episode psychosis given the patient's age. In the course of his admission, the patient's clinical condition deteriorated culminating in a sudden altered mental status which prompted a transfer to the medical floors and further investigations. A head CT scan and a pituitary MRI revealed a near total resection of the pituitary while laboratory investigations revealed hyponatremia and a grossly low hormone profile. The progression of these events casts doubts on our admitting diagnosis as the primary cause of the patient's symptoms. The patient's clinical condition improved only when his endocrinopathy was treated with hormone replacement, fluids, and electrolyte correction in addition to antipsychotics. An inability to verify the patient's psychiatric history and a remote history of pituitary resection several decades earlier, unknown to the treating team, added to the diagnostic conundrum. We revised the diagnosis to neuropsychiatric manifestations secondary to an organic brain syndrome due to a partial pituitary resection. The patient was discharged with no symptoms of psychosis, good insight, judgment, and good reality testing.
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spelling pubmed-54390682017-05-31 Neuropsychiatric Manifestations in a Patient with Panhypopituitarism Jegede, Oluwole Jeyakumar, Ajouka Balakumar, Thyarapan Raghu, Alyssa Chang, Katherine I. Soewono, Katarina Gustave, Mario Jolayemi, Ayodeji Case Rep Psychiatry Case Report We present a case of an incidental diagnosis of panhypopituitarism in a 68-year-old African American man admitted to our psychiatric inpatient unit with symptoms suggestive of schizophrenia. The case was unusual as a first-episode psychosis given the patient's age. In the course of his admission, the patient's clinical condition deteriorated culminating in a sudden altered mental status which prompted a transfer to the medical floors and further investigations. A head CT scan and a pituitary MRI revealed a near total resection of the pituitary while laboratory investigations revealed hyponatremia and a grossly low hormone profile. The progression of these events casts doubts on our admitting diagnosis as the primary cause of the patient's symptoms. The patient's clinical condition improved only when his endocrinopathy was treated with hormone replacement, fluids, and electrolyte correction in addition to antipsychotics. An inability to verify the patient's psychiatric history and a remote history of pituitary resection several decades earlier, unknown to the treating team, added to the diagnostic conundrum. We revised the diagnosis to neuropsychiatric manifestations secondary to an organic brain syndrome due to a partial pituitary resection. The patient was discharged with no symptoms of psychosis, good insight, judgment, and good reality testing. Hindawi 2017 2017-05-08 /pmc/articles/PMC5439068/ /pubmed/28567321 http://dx.doi.org/10.1155/2017/5082687 Text en Copyright © 2017 Oluwole Jegede et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Jegede, Oluwole
Jeyakumar, Ajouka
Balakumar, Thyarapan
Raghu, Alyssa
Chang, Katherine I.
Soewono, Katarina
Gustave, Mario
Jolayemi, Ayodeji
Neuropsychiatric Manifestations in a Patient with Panhypopituitarism
title Neuropsychiatric Manifestations in a Patient with Panhypopituitarism
title_full Neuropsychiatric Manifestations in a Patient with Panhypopituitarism
title_fullStr Neuropsychiatric Manifestations in a Patient with Panhypopituitarism
title_full_unstemmed Neuropsychiatric Manifestations in a Patient with Panhypopituitarism
title_short Neuropsychiatric Manifestations in a Patient with Panhypopituitarism
title_sort neuropsychiatric manifestations in a patient with panhypopituitarism
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439068/
https://www.ncbi.nlm.nih.gov/pubmed/28567321
http://dx.doi.org/10.1155/2017/5082687
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