A Case of Delusional Pregnancy in a Medical Graduate with Pituitary Microadenoma.

BACKGROUND: Delusion of pregnancy is a false and fixed belief of being pregnant despite factual evidence to the contrary. Both biological and psychological factors have been implicated in its causation. As prolactin directs metabolic and behavioural adaptations to the pregnant state, hyperprolactinemia is one of the leading causes. CASE DESCRIPTION: A 27yrs old female, married, medical professional, belonging to Hindu joint family of upper socio-economic status presented to us claiming she was 8.5 months pregnant, along with irritable mood, nausea, excessive weight gain, increased appetite and craving for food which she attributed to her pregnancy, while last menstrual period was a month ago. With history of psychotic illness in patient›s maternal aunt,disturbed emotional environment during formative years and induced abortion at 3months of gestation in first pregnancy. On physical examination, central obesity and stretch marks were noted. No other objective signs of pregnancy were present. On mental status examination, delusion of pregnancy was elicited. Diagnosis of somatic type persistent delusional disorder was considered. During the course of hospital stay of 1 month, obstetric opinion was taken in view of amenorrhea since admission, following investigations were done. Serum prolactin was 220ng/mL and non-contrast MRI brain revealed Pituitary Microadenoma for which cabergoline 0.25mg bi weekly was started by endocrinologist, on which menstrual cycles resumed. She was discharged on oral Risperidone 10mg. On subsequent follow-up, delusions resolved and Risperidone was cross tapered with Aripiprazole. CONCLUSION: Present case highlights a rare case of delusional disorder, with delusion of pregnancy with possible trigger as hyperprolactinemia secondary to pituitary microadenoma.