Management of psychosis in the course of cushing syndrome: a review

Approximately 8% of patients with Cushing syndrome can develop psychosis. Current knowledge on the effective management of psychosis in the course of Cushing syndrome is based mostly on case reports. Treatment is considered difficult and patients’ responses vary. In only one of the analyzed cases, administration of atypical antipsychotic drugs was sufficient to control the psychosis. In none of the cases were typical antipsychotics effective. Some authors reported cessation of psychotic symptoms after treatment with steroidogenesis inhibitors, glucocorticoid receptor antagonists or dopamine receptor agonists; however, in others, surgical removal of the underlying cause of Cushing syndrome was necessary. There are also reports of patients who required additional psychotropic medications after successful surgery. Additional studies are required to define the most effective therapeutic approach.