Acromegaly Presenting as Psychotic Disorder in a Patient with Familial Autosomal Dominant Polycystic Kidney Disease

Objective: To describe a rare case of Acromegaly presenting as psychotic disorder in a woman with familial autosomal dominant polycystic kidney disease (ADPKD). Method: Single case report. Results: We describe the case of a 50 year old woman, who presented with an acute psychotic episode. She had polycystic disease of kidney and liver and family history of polycystic disease. She presented with persecutory delusions, perceptual abnormalities, disorganisation and marked fluctuation in her behaviour. An urgent CT and subsequent MRI scan revealed a pituitary macroadenoma, extending into the cavernous sinus. The initial diagnosis of prolactinoma was revised to acromegaly. Her symptoms responded to combination of olanzapine and valproic acid, followed by transsphenoidal resection of the adenoma. Conclusions: This case highlights the need for investigation, especially of neuroimaging, in atypical presentations of psychosis, which may be first manifestation of rare disorders like acromegaly (German J Psychiatry 2006; 9: 136-138).