A Case of Cushing Syndrome Misdiagnosed as Treatment-Resistant Depression

Cushing's syndrome is a systemic disease resulting from chronic exposure to cortisol excess, occurring at a rate of 0.7 to 2.4 per million per year. 1 Santos A Resmini E Pascual JC et al. Psychiatric symptoms in patients with Cushing's syndrome: prevalence, diagnosis and management. Drugs. 2017; 77: 829-842 Crossref PubMed Scopus (26) Google Scholar ,2 Newell-Price J Bertagna X Grossman AB et al. Cushing's syndrome. Lancet. 2006; 367: 1605-1617 Abstract Full Text Full Text PDF PubMed Scopus (918) Google Scholar An abundance of glucocorticoid receptors found in the central nervous system makes the brain susceptible to states of glucocorticoid excess. 1 Santos A Resmini E Pascual JC et al. Psychiatric symptoms in patients with Cushing's syndrome: prevalence, diagnosis and management. Drugs. 2017; 77: 829-842 Crossref PubMed Scopus (26) Google Scholar Depression is the most common neuropsychiatric manifestation of Cushing's syndrome, present in 50%-80% of patients with active disease, with suicidal ideation reported at a rate of 17%. 1 Santos A Resmini E Pascual JC et al. Psychiatric symptoms in patients with Cushing's syndrome: prevalence, diagnosis and management. Drugs. 2017; 77: 829-842 Crossref PubMed Scopus (26) Google Scholar Neuropsychiatric symptoms can precede the onset of Cushing's syndrome, 3 Bratek A Kozmin-Burzynska A Gorniak E et al. Psychiatric disorders associated with Cushing's syndrome. Psychiatr Danub. 2015; 27: S339-S343 PubMed Google Scholar making diagnosis challenging.