Losing My Mind: An Uncommon Presentation of Cushing’s Disease

      A 44-year-old Chinese woman was found to have markedly elevated plasma glucose of 19.7 mmol/L during routine follow-up with her psychiatrist. After excluding a hyperglycemic crisis, she was advised on lifestyle management and initiated on metformin 500 mg thrice daily, and referred to the Endocrinology clinic for newly diagnosed diabetes mellitus.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Arnaldi G.
        • Angeli A.
        • Atkinson A.B.
        • et al.
        Diagnosis and complications of Cushing’s syndrome: a consensus statement.
        J Clin Endocrinol Metab. 2003; 88: 5593-5602
        • Chong B.W.
        • Kucharcyzk W.
        • Singer W.
        • George S.
        Pituitary gland MR: a comparative study of healthy volunteers and patients with microadenomas.
        AJNR Am J Neuroradiol. 1994; 15: 675-679
        • Nieman L.K.
        • Biller B.M.K.
        • Findling J.W.
        • et al.
        The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline.
        J Clin Endocrinol Metab. 2008; 93: 1526-1540
        • Findling J.W.
        • Raff H.
        Diagnosis of endocrine disease: differentiation of pathologic/neoplastic hypercortisolism (Cushing’s syndrome) from physiologic/non-neoplastic hypercortisolism (formerly known as pseudo-Cushing’s syndrome).
        Eur J Endocrinol. 2017; 176: R205-R216
        • Santos A.
        • Resmini E.
        • Pascual J.C.
        • Crespo I.
        • Webb S.M.
        Psychiatric symptoms in patients with Cushing’s syndrome: prevalence, diagnosis and management.
        Drugs. 2017; 77: 829-842
        • Kelly W.F.
        Psychiatric aspects of Cushing’s syndrome.
        QJM Mon J Assoc Physicians. 1996; 89: 543-551
        • Gerson S.N.
        • Miclat R.
        Cushing disease presenting as atypical psychosis followed by sudden death.
        Can J Psychiatr. 1985; 30: 223-224
        • Hirsch D.
        • Orr G.
        • Kantarovich V.
        • Hermesh H.
        • Stern E.
        • Blum I.
        Cushing’s syndrome presenting as a schizophrenia-like psychotic state.
        Isr J Psychiatry Relat Sci. 2000; 37: 46-50
        • Zielasek J.
        • Bender G.
        • Schlesinger S.
        • et al.
        A woman who gained weight and became schizophrenic.
        Lancet. 2002; 360: 1392
        • Tang A.
        • O’Sullivan A.J.
        • Diamond T.
        • Gerard A.
        • Campbell P.
        Psychiatric symptoms as a clinical presentation of Cushing’s syndrome.
        Ann General Psychiatry. 2013; 12: 23
        • Rasmussen S.A.
        • Rosebush P.I.
        • Smyth H.S.
        • Mazurek M.F.
        Cushing disease presenting as primary psychiatric illness: a case report and literature review.
        J Psychiatr Pract. 2015; 21: 449-457
        • Fujii Y.
        • Mizoguchi Y.
        • Masuoka J.
        • et al.
        Cushing’s syndrome and psychosis: a case report and literature review.
        Prim Care Companion CNS Disord. 2018; 20
        • Nieman L.K.
        • Biller B.M.K.
        • Findling J.W.
        • et al.
        Treatment of Cushing’s syndrome: an endocrine society clinical practice guideline.
        J Clin Endocrinol Metab. 2015; 100: 2807-2831