Psychological manifestations can be noted in patients with pituitary hypofunction or injuries after surgery and radiotherapy. We report on a 38-year-old female with acute adrenal insufficiency who presented with an affective disorder. The patient was brought to our emergency department because of general weakness and fever. Low plasma glucose concentration and low blood pressure were noted at arrival. She expressed mood change and persecutive thoughts. The brain MRI demonstrated no obvious brain damage except empty sella. The cortisol level was undetectable. Intravenous hydrocortisone was administered after the diagnosis of acute adrenal insufficiency. The patient improved physically after treatment, but social withdrawal and inappropriate affect persisted. We present the case and review the relevant literature to impress on physicians that the cognitive disorders in hypopituitarism can result from not only hormone insufficiency, but also the influences of pituitary tumor surgery and radiotherapy on neuropsychological functions.