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Cushing’s disease presenting with psychosis
  1. Ahmed Saeed Mubarak Mohamed1,
  2. Ahmed Iqbal2,
  3. Suveera Prasad3,
  4. Nigel Hoggard4,
  5. Daniel Blackburn1
  1. 1 Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2 Department of Oncology and metabolism, The medical School, The University of Sheffield, Sheffield, UK
  3. 3 Adult Inpatient Mental Health Unit, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
  4. 4 University MRI Unit, IICD, Royal Hallamshire Hospital, The University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Daniel Blackburn, Sheffield Teaching Hospitals NHS Foundation Trust Department of Clinical Neurology, Sheffield S10 2JF, UK; d.blackburn{at}sheffield.ac.uk

Abstract

Cushing’s disease is a rare endocrine condition in which a pituitary corticotroph adenoma drives excess adrenal cortisol production, and is one cause of endogenous Cushing’s syndrome. We present a young woman with 3 weeks of headaches and cognitive disturbance who subsequently developed florid psychosis requiring multiple admissions under neurology and psychiatry. Her clinical stigmata of hypercortisolism and biochemical abnormalities prompted an MR scan of the pituitary, which confirmed a pituitary microadenoma. Treatment with metyrapone and subsequent surgery led to complete recovery within 2 months. Cushing’s disease commonly causes neuropsychiatric symptoms and can present with psychosis. Diagnosing Cushing’s disease can be challenging, but with early diagnosis and treatment it has an excellent prognosis.

  • psychosis
  • puerperal
  • neuroendocrinology
  • neurosurgery

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Footnotes

  • Contributors (ASMM, AI, SP and DJB) have contributed significantly to the writing to the writing and editing of this manuscript. NH selected and commented on the images.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned. Externally peer reviewed by John Thorpe, Peterborough, UK.

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