Hypopituitarism induced by corticosteroid abuse – case report

Hypopituitarism is a condition in which the anterior pituitary lobe is insufficient, leading to hormone deficiencies. Individuals with hypopituitarism who do not receive replacement therapy may experience an adrenal crisis, a life-threatening condition that can be traumatic for some patients and trigger panic and abnormal fear of death. We present a 37-year-old male patient who developed hypopituitarism and consequently panic attacks and agoraphobia. He was diagnosed with Hashimoto’s thyroiditis at the age of 19. The patient has worked night shifts in the emergency department while attempting to attend the university during the day. Dissatisfied with his appearance, he started weight training and using testosterone. Excessive exercise caused back pain, treated with injections of ketoprofen, methylprednisolone and diazepam. Employed in the emergency department, he began self-administering methylprednisolone injections. During the work-up for erectile dysfunction, he was found to have deficiencies in testosterone, growth hormone, and cortisol. Since he concealed his steroid use, idiopathic panhypopituitarism was diagnosed. Irregular adherence to therapy led to an adrenal crisis. This triggered several panic attacks, which prompted him to admit previous abuse. He is now under regular endocrinological follow-up with gradual dose reduction of hydrocortisone and testosterone. Psychiatric treatment, including pharmacotherapy and psychotherapy was started, vortioxetine up to 20 mg/day and alprazolam up to 1.5 mg/day were prescribed, and remission of psychiatric symptoms was achieved. His overall condition is improving. Hypopituitarism can be followed by psychiatric issues, and psychiatric problems can be associated with the abuse of psychoactive substances, which should be considered in idiopathic cases.