PT  - JOURNAL ARTICLE
AU  - Samer El Hayek
AU  - Joseph El-Khoury
TI  - Late-onset mania associated with corticosteroids and small cell lung carcinoma
AID  - 10.1136/bcr-2019-233403
DP  - 2020 Feb 01
TA  - BMJ Case Reports
PG  - e233403
VI  - 13
IP  - 2
4099  - http://casereports.bmj.com/content/13/2/e233403.short
4100  - http://casereports.bmj.com/content/13/2/e233403.full
SO  - BMJ Case Reports2020 Feb 01; 13
AB  - Episodes of mania typically occur in the context of bipolar disorder, with an average age of onset of 25 years. A condition with identical symptoms, known as secondary mania, generally occurs in isolation in older adults and has an identifiable organic etiology. Here, we report a 57-year-old man who presented to the emergency department with a 3 weeks history of sudden onset mania with psychotic symptoms. He had no previous psychiatric history, and his presentation coincided with the initiation of a course of steroids. Despite the absence of physical symptoms, investigations revealed a previously undetected adrenocorticotropic hormone-releasing small cell lung carcinoma that led to his death within months. This case highlights the complexity of distinguishing primary from secondary mania when it occurs after the peak incidence period of early adulthood. Undertaking a comprehensive medical workup is generally recommended.