The appearance of psychotic and affective symptoms in the patients treated with steroids has been described in the literature; however, there are limited data on factors affecting development of these disturbances.

38 year-old female with past medical history of depression, long-standing hypothyroidism and adrenal insufficiency on both thyroid and adrenal hormone replacement therapies (RT), was admitted to psychiatric ward due to psychomotor agitation, tangentiality of though and labile affect. the manic episode was diagnosed. the significant hyponatremia was found and corrected. After the reduction of the doses of hormone replacement therapy, and the treatment with valproic acid and haloperidol the manic symptoms were eliminated.

Steroid RT may have a significant effect on the development of psychiatric symptoms in that patients; however, presence of hyponatremia and simultaneous thyroid RT could be important contributing factors. Severity of the symptoms requiring antipsychotic medication did not allow verifying the hypothesis that reduction in the dose of steroids might be only necessary treatment in steroids-induced psychiatric disturbances. However as the only one depressive episode in the past history was connected with the significant adrenal insufficiency with hypothyroidism, the current episode in that patient was diagnosed as mania related to hormonal replacement therapy rather than to bipolar affective disorder. This case points out an increased risk of psychotic disturbances in the course of the treatment with steroids and a need to identify additional risk factors in the past history, somatic state and metabolic abnormalities.