Abstract
A 48-year-old woman who had had a bilateral adrenalectomy for Cushing's syndrome developed severe psychotic symptoms that were unresponsive to psychotropic drugs as long as she was taking prednisone (PRED) as replacement therapy. However, after she was switched to a regimen of cortisol (CORT) and fludrocortone (FLUD) the psychopathology disappeared. Mechanisms related to the differences in the interaction of natural (e.g. CORT) and synthetic (e.g. PRED) corticosteroids with the central glucocorticoid and mineralocorticoid receptors may explain the different effects upon psychopathology.
MeSH terms
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Adrenalectomy*
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Affect / drug effects*
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Affect / physiology
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Cushing Syndrome / physiopathology
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Cushing Syndrome / psychology
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Cushing Syndrome / surgery*
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Drug Therapy, Combination
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Female
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Fludrocortisone / administration & dosage*
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Fludrocortisone / adverse effects
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Humans
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Hydrocortisone / administration & dosage*
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Hydrocortisone / adverse effects
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Hypothalamo-Hypophyseal System / drug effects
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Hypothalamo-Hypophyseal System / physiopathology
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Middle Aged
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Neurocognitive Disorders / drug therapy*
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Neurocognitive Disorders / physiopathology
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Neurocognitive Disorders / psychology
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Pituitary-Adrenal System / drug effects
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Pituitary-Adrenal System / physiopathology
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Postoperative Complications / drug therapy*
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Postoperative Complications / physiopathology
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Postoperative Complications / psychology
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Prednisone / administration & dosage*
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Prednisone / adverse effects
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Receptors, Glucocorticoid / drug effects
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Receptors, Glucocorticoid / physiology
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Receptors, Mineralocorticoid / drug effects
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Receptors, Mineralocorticoid / physiology
Substances
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Receptors, Glucocorticoid
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Receptors, Mineralocorticoid
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Fludrocortisone
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Prednisone
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Hydrocortisone