An Unusual Case of Steroid-Induced Psychosis versus Post-operative Neuropsychiatric Complication Following Pituitary Macroadenoma Surgery
Vipul Janardan*, Kiran Kumar K and Rajmani
Abstract
Background: Steroid-induced psychosis is a recognised adverse effect of systemic glucocorticoid therapy but is rarely described after short-term perioperative steroid replacement for pituitary surgery. Only a handful of such cases have been reported worldwide [1].
Case presentation: We describe a 49-year-old woman with hypertension and no past or family psychiatric history who underwent left pterional craniotomy and near-total excision of a pituitary macroadenoma. She received peri-operative hydrocortisone replacement. On post-operative day (POD) 2 she developed acute behavioural changes, persecutory ideas and vivid visual hallucinations. She was fully conscious and oriented, with preserved vital signs and no focal neurological deficits. Laboratory parameters, including serum electrolytes, were within normal limits, and neuroimaging did not show new structural lesions. A diagnosis of steroid-induced psychosis was considered in the differential alongside post-operative delirium and surgery-related complications. Steroids were rapidly tapered and atypical antipsychotic medication was initiated, leading to gradual resolution of symptoms over the next week.
Conclusion: This case illustrates the diagnostic challenge of distinguishing steroid-induced psychosis from post-operative neuropsychiatric complications after pituitary surgery. Clinicians should maintain a high index of suspicion for glucocorticoid-related psychiatric adverse effects even when using “replacement” doses, carefully monitor patients in the early post-operative period, and individualise peri-operative steroid protocols.
