First Psychotic Episode: Panhypopituitarism and Psychosis in a Female Patient

Endocrine and psychiatric disorders frequently overlap, and neuropsychiatric symptoms can be the primary manifestation of an underlying endocrinopathy. This case report describes a 69-year-old Caucasian female admitted to a psychiatry department with severe persecutory and mystical delusions, auditory-verbal and visual hallucinations, and alopecia. Further investigation revealed a psychotic disorder attributed to panhypopituitarism, secondary to poor adherence to hormone replacement therapy following a pituitary resection in 1990. Following treatment optimization, the patient showed remarkable clinical improvement and was discharged after 31 days. This case highlights that while psychosis is a rare presentation of panhypopituitarism, it is crucial to rule out treatable organic etiologies in patients presenting with acute psychiatric features, preventing diagnostic delays and ensuring appropriate targeted therapy.