Lisa Sanders always delivers. This case history is rather amazing – Mysterious Psychosis.
While I deduced the diagnosis, it was only because I knew that this was an Occam’s Razor case. I might have stumbled into this diagnosis – but would not have know the impact of this diagnosis.
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This a good case. This relatively young woman provides one important fundamental lesson that was drilled to us in Canada. The vital signs are always relevant. It would be instructive to see what clues she gave to her ultimate diagnosis in her first presentations.
She notes that she had had hypertensive bouts in the earlier phases of the disease. She was also a “slender” hypertensive. Patients with bipolar disorder are often obese.
There is mention that there were no complaints of sweating, palpitations and headaches. Harrison’s does not mention psychosis in its chapter on pheochromocytoma. So she was not the most obvious presentation of pheochromocytoma.
My thoughts came to Concerta. Could the synergic interaction of Concerta and the excessive catecholamine secretions by the pheochromocytoma have led to the psychosis? There appear to be no such cases in pubmed.
Bohdan A. Oryshkevich, MD, MPH