Acute Psychosis and Suicide Attempt As Manifestations of Severe Endogenous Hypercortisolism: A Case Report of Adrenocorticotropic Hormone (ACTH)-Independent Cushing Syndrome - Cureus

Cushing syndrome is an endocrine disorder caused by chronic exposure to excess cortisol. Although neuropsychiatric manifestations are common, progression to acute psychosis with a suicide attempt is exceptionally rare. We present the case of a patient with adrenocorticotropic hormone (ACTH)-independent Cushing syndrome secondary to a cortisol-secreting adrenocortical carcinoma, whose predominant neuropsychiatric manifestation was an acute psychotic episode with a suicide attempt. The patient had a five-month history of Cushingoid signs and symptoms, followed by one week of emotional lability that rapidly progressed to an acute psychotic episode with a suicide attempt prior to surgical resection, requiring hospitalization and psychiatric evaluation. Open adrenalectomy was performed, and histopathological examination confirmed a cortisol-secreting adrenocortical carcinoma. Subsequently, the patient experienced rapid resolution of psychiatric symptoms and a favorable clinical course following tumor resection. This case highlights the importance of considering hypercortisolism as a potentially reversible cause of acute psychosis and suicidal behavior. It also underscores the need to in

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