Cushing's Syndrome Presenting with Depression as the Initial Manifestation: A Case Report and Literature Review.

Background: In approximately 12% of Cushing's syndrome (CS) cases, psychiatric symptoms, such as depression and anxiety, are the initial manifestation, obscuring the diagnosis and leading to delayed treatment.

Case summary: This case report describes a patient whose initial symptom of CS was low mood. Eighteen months later, typical clinical features of CS emerged, and the diagnosis was confirmed through dexamethasone suppression tests and adrenal computed tomography. This report also reviews relevant literature, analyzing the clinical features, pathogenesis, treatment, and prognosis of CS.

Conclusion: In patients presenting with low mood or depression but no typical CS features, clinicians should consider CS as a potential underlying cause. Endocrinologists should be vigilant when evaluating patients with mental disorders. Timely diagnostic evaluations can lead to earlier diagnosis and treatment, ultimately improving prognosis.