Catatonia Induced by an ACTH-Secreting Neuroendocrine Tumor: A Case Report

ABSTRACT Objective: The catatonic reaction is a striking syndrome associated with a variety of psychiatric and medical conditions, including high-dose corticosteroid therapy. We present the case of a patient who suffered increasing mental disturbance to the point of catatonia in the setting of an adrenocorticotropic hormone (ACTH)-secreting neuroendocrine tumor and severe hypercortisolism. We describe the presentation and course of treatment with benzodiazepines and pancreaticoduodenectomy. Methods: A PubMed literature search was done to summarize and compare this case to other reported cases of psychiatric disturbances in the setting of hypercortisolism. Results: Our literature review of case reports from 1952–2011 noted 7 cases of catatonic reactions to glucocorticoid or ACTH administration. We hypothesize that the catatonia in our patient was caused by elevated levels of cortisol secondary to ectopic ACTH overproduction, making this report the first documented case of catatonia secondary to an ACTH-secreting neuroendocrine tumor. Conclusion: Catatonia is a rare clinical presentation of an ACTH-secreting neuroendocrine tumor, which can be successfully controlled with benzodiazepines and definitively treated with pancreaticoduodenectomy. Abbreviations: ACTH adrenocorticotropic hormone CT computed tomography ECT electroconvulsive therapy NMDA N-methyl-D-aspartate POD postoperative day