A 46-year old man is admitted to hospital following a first time presentation of psychosis that involved barricading himself inside a neighbour’s home. At admission he appears disorganised with slow movements and speech. His rambling reveals bizarre delusional beliefs of a paranoid and persecutory nature. At moments he shows aggression towards staff but when examines reports occasional dizziness and an intolerance of cold. Physical examination reveals cool peripheries, sparse axillary and pubic hair, and soft adult-sized testicles. The investigating team suspect hypothyroidism and a complex series of investigations and therapies follows.Guests Dr Peak Man Mah FRACP (Lyell McEwin Hospital, University of Adelaide) Dr Malcolm Borg (Royal Adelaide Hospital) HostsAssociate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide)Mic Cavazzini DPhilProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physician Simeon Wong and medical student Cindy Shi. Key Reference (Spoiler Alert)* * * * *Panhypopituitarism and psychosis in a male patient [Aust N Z J Psychiatry. 2010] Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.

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