Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Neurol. May 31, 2023; 9(3): 28-36
Published online May 31, 2023. doi: 10.5316/wjn.v9.i3.28
Steroid-induced psychosis related to pituitary adenoma status post trans-sphenoid excision and a history of psychiatric illness: A case report
Denmarc Romero Aranas, Jovy Anne Tangalin
Denmarc Romero Aranas, Jovy Anne Tangalin, Department of Psychiatry, Baguio General Hospital - Medical Center, Baguio 2600, Benguet, Philippines
Author contributions: Aranas DR was the correspondence author and the one who submitted the manuscript; Aranas DR and Tangalin JA edited the manuscript, actively reviewed and revised the manuscript.
Informed consent statement: Informed consent was secured.
Conflict-of-interest statement: All authors declare having no conflicts of interest related to this study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Denmarc Romero Aranas, MD, Doctor, Department of Psychiatry, Baguio General Hospital - Medical Center, Governor Pack Road, BGHMC Compound, Psychiatry Building, 2nd Flr., Baguio 2600, Benguet, Philippines. aranasdenmarc@gmail.com
Received: April 18, 2023
Peer-review started: April 18, 2023
First decision: May 9, 2023
Revised: May 10, 2023
Accepted: May 19, 2023
Article in press: May 19, 2023
Published online: May 31, 2023
Abstract
BACKGROUND

Steroid-induced psychosis is a common adverse effect of steroid exposure. Reported cases were mostly related to rheumatologic disease. Despite its high incidence, there is only one case reported related to perioperative steroid replacement for pituitary adenoma surgery. This manuscript presents the second case of such and compared the two with the latest literature review of steroid-induced psychosis.

CASE SUMMARY

This is a case of an adult male with a chief complaint of auditory hallucinations and was referred by Neurosurgery to Psychiatry Out-patient department. He was diagnosed with pituitary adenoma who underwent trans-sphenoid excision of the mass from which steroid exposure led to steroid-induced psychosis. Also, patient had a history of psychiatric illness of severe depressive episode. At the out-patient department, patient was started on antipsychotic, Risperidone, which led to eventual improvement of his symptoms.

CONCLUSION

The two cases of pituitary adenoma surgery with steroid-induced psychosis had almost similar clinical profile with the latest literature review of steroid-induced psychosis. However, the present case highlights the association of psychiatric illness in predisposing an individual in developing it. Also, this manuscript emphasizes that early recognition of steroid-induced psychosis leads to better prognosis. Multispecialty treatment is vital in the holistic management of the patient with timely referral and close coordination.

Keywords: Steroid-induced psychosis, Dexamethasone, Complication, Pituitary adenoma, Perioperative supplementation, Case report

Core Tip: This case report supports the association between a history of psychiatric illness with higher incidence in developing steroid-induced psychosis. Also, the higher dosage of steroid exposure can cause earlier manifestation of psychotic symptoms. Steroid dosage was observed to be directly proportional to the severity of psychosis. Later improvement may be due to the delayed initiation of antipsychotics. Multispecialty treatment is vital in the holistic management of the patient with timely referral and close coordination. Lastly, proper determination of indication and minimum dose of steroids in patients undergoing pituitary surgery must be done so as to avoid any perturbing complications.