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An oral dose of dexamethasone (1 mg) at 11 PM did not suppress plasma cortisol levels (25.5 μg/d L) the following morning.Abdominal computed tomography demonstrated a left adrenal tumor, and I-adosterol scan revealed marked uptake on the same side (Figure 2), suggesting a diagnosis of primary adrenal Cushing’s syndrome.Case report A 19-year-old Japanese male visited a local general hospital in July 2011 after 5 days of behavioral abnormalities, such as money wasting or nighttime wandering. He had never consumed alcohol or smoked cigarettes.He had been healthy until the appearance of a rounded face 12 months prior to the visit, and 9 months later he was found to have hypertension upon routine medical checkup.A 19-year-old Japanese male visited a local hospital following 5 days of behavioral abnormalities, such as money wasting or nighttime wandering.He had hypertension and a 1-year history of a rounded face.His height and weight were 168.8 cm and 56.3 kg, respectively.

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Because of high random plasma cortisol levels (28.7 µg/d L) at 10 AM, he was referred to our hospital in August 2011.

Because the laboratory examination showed hypokalemia and high random plasma cortisol levels (28.7 μg/d L) at 10 AM, he was referred to our hospital for further endocrine function evaluation in August 2011.

Figure 1 Transverse T1-weighted magnetic resonance images of the brain.

In summary, the young age at onset and the short duration of Cushing’s syndrome probably contributed to the rapid recovery of both cognitive dysfunction and brain atrophy in our patient.

Cushing’s syndrome should be considered as a possible etiological factor in patients with cognitive impairment and brain atrophy that is atypical for their age.

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