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

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 include endocrine disorders in the differential diagnosis of de novo psychosis and to incorporate early psychiatric evaluation into the multidisciplinary management of patients with Cushing syndrome, particularly in the presence of severe neuropsychiatric manifestations.