Steroid-induced psychosis related to pituitary adenoma status post trans-sphenoid excision and a history of psychiatric illness: A case report

Table 1 Summarized clinical profile of steroid-induced psychosis compared with the clinical profile of the 2 cases of steroid-induced psychosis associated with excision of pituitary adenoma

Parameters	Latest literature review of steroid-induced psychosis (Huynh et al[4], 2021)	Mizutani et al[3], 2015	Aranas & Tangalin, 2023
Age	Mean age of 42.54 yr old	35 yr old	47 yr old
Sex	Cases were mostly male; Female sex – proven risk factor	Male	Male
Indication for steroids	Suppression of inflammatory processes and the immune system	Perioperative steroid replacement	Perioperative steroid replacement
Steroids (prednisone equivalent in average (mg/d)	Prednisone, Prednisolone, Methylprednisolone, Dexamethasone, Hydrocortisone, Triamcinolone, Betamethasone; (15-1250 mg of prednisone/d)	Hydrocortisone 10-300 mg/d; (2.5-75 mg of prednisone/d)	Dexamethasone 2–16 mg/d; (26.7-106.7 mg of prednisone or its equivalent per day)
Duration of steroid therapy	Shortest: < 2 d; Longest: 2 yr; Mostly within 3 d up to 6 mo	8 d	11 d
Onset of psychosis from 1st dose of steroids	Earliest: < 24 h; Latest: After 2 yr of chronic use; Mostly within 2 da to up to 2 wk	4 d	1 d
Symptomatology	Most common: Delusions & hallucinations; Others: Insomnia, agitation, irritability, combativeness, confusion, cognitive impairment, mania, depression, and suicidal ideation	Elated and irritable mood, grandiose and persecutory delusions, anxiety, and agitation	Anxious mood, persecutory delusions, thought broadcasting, auditory hallucination, agitation
History of Psychiatric illness	Majority without psychiatric illness; Anxiety disorder; Depressive disorder	None	Severe depressive episode without psychotic symptoms
Steroid management following diagnosis of psychosis	Discontinued – quicker resolution; Tapered	Tapered (7 d)	Tapered (11 d)
Pharmacologic intervention	Typical antipsychotics: Haloperidol, Levomepromazine, perphenazine, & zuclopenthixol; Atypical antipsychotics: Risperidone, Olanzapine & Quetiapine; Mood stabilizers: Lithium & Valproic acid; Benzodiazepines: Clonazepam, diazepam, lorazepam, & Flunitrazepam	Atypical antipsychotic: Risperidone	Atypical antipsychotic: Risperidone
Recovery/Improvement	Earliest: 1 mo; Longest: 8 wk	4 d	3 wk