To describe a case of a patient who initially presented with multiple neurological symptoms in addition to other new medical problems who was found to have Cushing’s syndrome secondary to an adrenal cortical carcinoma.

Patient who initially was diagnosed with a radicular neuritis possibly related to Lyme disease accompanied by multiple neurological symptoms who was found to have Cushing Syndrome after extensive diagnostic work up.

61 years old man with history of hypertension, syphilis who presented in 8/2017 with progressive right anterior thigh numbness, lower back pain and weakness, slurred speech preceded by presumed bug bite with target lesion. His exam showed decreased abnormal vibration light touch, pinprick and temperature on his right thigh in the L2-L3 dermatomal distribution accompanied by weakness isolated to his right quadriceps muscle. His BP was uncontrolled. Labs remarkable for hypokalemia, Lyme Serum Ig G and Ig M was positive. Total Spine MRI was unremarkable. Lumbar puncture showed mildly elevated protein. He completed a 28 day course of ceftriaxone for presumed Lyme radiculoneuritis. During the following months, he had worsening subjective cognitive symptoms including short term memory, mental fogginess, dizziness, fatigue, weight gain. He was diagnosed with new diabetes. He also complained of new skin bruising, worsening fatigue and excessive sleep. After extensive medical work up, he was found to have adrenal Cushing’s Syndrome secondary to a 5 cm adrenal oncocytic cortical carcinoma. He subsequently had total surgical resection and after his treatment, all his neurological symptoms, his diabetes and uncontrolled hypertension resolved.