Diagnostic and Therapeutic Implications of Organic Delusional Disorder due to Tuberculous Adrenalitis

Primary adrenal insufficiency rarely occurs due to infections, which consequently involves destruction or dysfunction of both adrenal cortices. Tuberculous adrenalitis is still a frequent cause of adrenal insufficiency in developing countries. We present the case of origin of multiple delusions along with recurrent spells of vomiting and giddiness in a patient with pulmonary tuberculosis (TB). A thorough medical history combined with a panel of biochemical and endocrine investigations revealed disseminated TB with choroid tubercles and adrenal infiltration leading to primary adrenal insufficiency. A diagnosis of organic delusional disorder secondary to disseminated TB-associated adrenal insufficiency was considered. The patient was managed with risperidone and antitubercular drugs. The psychosis improved and the patient was stable during the follow-up. The present case report adds to the literature on diagnostic challenges associated with psychosis due to adrenal insufficiency secondary to disseminated TB.