POMC and Cushing syndrome due to macronodular adrenal hyperplasia: Psychiatric disturbances are frequently seen in patients with Cushing syndrome, the most common of which are depression and impaired cognition.1, 5 Severe psychosis related to increased cortisol secretion, such as emotional lability or mental disturbance, is rare, especially as the initial clinical manifestation of ectopic ACTH‐producing tumors.