Cushing’s Disease Presenting with Functional Neurological (Conversion) Disorder 2023 Ashrafzadeh et al

While psychiatric manifestations are common in patients with Cushing’s syndrome (CS), to our knowledge, there are no reported cases of CS presenting with functional neurological disorder (FND), a neuropsychiatric condition in which patients experience neurological symptoms, such as motor dysfunctions, sensory symptoms, speech disorders, or nonepileptic seizures, in the absence of neurological disease.

Here, we report a case of a complex patient with Cushing’s disease who presented with multiple FND symptoms including nonepileptic seizures, bilateral lower extremity paralysis, decreased finger flexion resulting in limited hand function, and stuttering. This case illustrates a rare psychiatric manifestation of CS presenting as multiple neurological complaints. Furthermore, we elucidate how a multidisciplinary treatment approach improved our patient’s FND symptoms.

Open access, https://www.hindawi.com/journals/crips/2023/1662271/

 

I get the impression that the authors looked up a list of symptoms for Cushing's on wikipedia then declared any other symptoms the patient suffered from as FND.

What would be more useful and less sadistic is for the patient to be treated for CS, get their thyroid checked, and get any nutrient deficiencies fixed then find out which symptoms still exist.

I don't normally stutter. But there have been occasions when I do when my thyroid is untreated or under-treated, and when I've been low in various nutrients, or when I'm so out of energy I can barely talk. I don't think this should imply that I have FND.

There is a relationship between cortisol levels and thyroid hormone levels, and thyroid issues affect the gut and nutrient absorption too - but this is rarely or never acknowledged by doctors.

So, someone has stiff fingers, and this is a symptom of FND? Medicine has gone mad.

My bold :

If anyone had to use a short sentence to describe CS it would be something like :

"CS is caused by patients having too much cortisol."

But the authors seem to be saying that CS may be caused by FND.

...

There are also mentions of the patient having hypokalemia (although I think it is mild) - and that can do unpleasant things to muscle function even when it is mild. One thing I didn't see in the paper is any reference to treating his low potassium and what effect that had on his muscle function. In fact, immediately after mentioning the low potassium they mention giving him a tranquiliser, not potassium.

The patient was a 28-year-old man who was bed-bound and could hardly move his lower body. Feeling the way he did isn't surprising.

I wonder if the stuttering mentioned is anything to do with his muscle function problems - and, naturally, once psych got involved he was put on an anti-psychotic - and they can cause huge problems with movement.

This just stunned me - my bold:

So, this poor man had Cushing's diagnosed a year before, which is known to cause symptoms that appear to be psychiatric, and he wasn't treated for the CS because he had psychiatric symptoms? !!!!!!

Hallelujah! Finally!

After treatment for his CS his symptoms started reducing and disappearing.

.

I am amazed that anyone published this case study. It is indicative of a total failure of the medical profession that almost paralysed a young man for a year. The authors should be embarrassed to publish this.

The only benefit to publishing this is it gives information to the medical profession on what symptoms they might see in neglected CS.

 

This is like a parody of bad science. The issue isn't with the ideologues anymore, it's with a system that has given up and enables and rewards pseudoscience.

A profession so deep in crisis it can't even see it has problems at all, is in denial it can even do any wrong.

 

I hope the hospitals and doctors involved in this man's "care" and who ignored the serious symptoms and diagnoses he had are sued for a huge amount of money for malpractice and negligence

 

It’s so strange that they published this. I hope he sues everyone involved in his “care” for malpractice.

 

Reasonable. One of the only good features of the US health care system is tort. Likely this makes it impossible to make a case since there can be a medical "expert" to dismiss the case on grounds of it being a conversion disorder case study.

Maybe not the only reason, but this is almost academic DARVO. They screwed up big time, and instead of accepting responsibility, they covered it up and blamed it on the patient.

Not the first time either. I'm pretty sure that an in-depth investigation, basically impossible, would find loads of cases like this. Seems like the only purpose of the conversion disorder is to harm people, sometimes twice over.

 

Perhaps one for Scott Simpson s medical errors series ?

 

@Joan Crawford