Ectopic Cushing’s syndrome triggering a bipolar affective disorder

Abstract

ABSTRACT Objective To report the case of a patient with Cushing’s syndrome (CS) resulting from an ectopic tumor producing adrenocorticotropic hormone (ACTH) in an unusual topography, triggering bipolar affective disorder (BAD) in a previously healthy patient. Method A case study. Interviews were conducted with the patient and family members to collect data. Information contained in medical records and exams was also used. Results A 63-year-old man, previously healthy, with a positive family history of psychiatric disorders. He presented with clinical changes and a maniform syndrome. After extensive clinical investigation, he was diagnosed with CS due to an ACTH-secreting neuroendocrine tumor in the ileum topography. Surgery was performed to excise the lesion and the patient improved rapidly of his clinical and psychiatric symptoms. However, different from the expected evolution, the patient returned to present new manic and depressive episodes, and was then diagnosed with BAD. The main hypothesis is that the psychiatric disorder was triggered by exposure to high levels of cortisol resulting from an ectopic ACTH-producing tumor in a genetically susceptible patient. Conclusions The present report illustrates the diagnostic difficulty of CS and draws attention to the frequent interface between CS and psychiatric manifestations. It highlights the importance of clinicians and psychiatrists to consider organic conditions such as CS as a differential diagnosis in the face of psychiatric symptoms with atypical presentation or an unsatisfactory response to treatment.

Keywords

• Bipolar disorder
• mania
• cushing
• psychiatric symptoms
• neuroendocrine tumor