Chronic Schizophrenia Presenting With Psychogenic Polydipsia Concealing Stage IV Uterine Adenocarcinoma: A Case Report

TL;DR

A 58-year-old woman with schizophrenia and psychogenic polydipsia had undiagnosed stage IV uterine cancer for years due to missed opportunities for early detection.

Contribution

This case report highlights how psychiatric symptoms can mask serious physical illnesses and underscores missed diagnostic opportunities in psychiatric care.

Findings

Psychiatric symptoms masked stage IV uterine adenocarcinoma for seven years.

Missed opportunities for early intervention included inadequate exams and delayed imaging.

Tumor marker tests indicated cancer, but diagnosis was delayed until 2022.

Abstract

Psychogenic polydipsia (PPD) may be commonly seen in patients suffering from schizophrenia. It remains unknown how often psychiatric illness can mask other more serious conditions. The patient is a 58-year-old female with chronic schizophrenia and PPD presenting to the emergency department (ED) with abdominal pain over a seven-year period from 2016 to 2022 with her symptoms attributed to a schizophrenia exacerbation with minimal to no diagnostic follow-up. After several ED admissions, in 2022, tumor marker tests were collected yielding concerning results for underlying cancer including CA125 85.9/50.1, CA19-9 >10, and CEA 0.3. A pelvic ultrasound was completed in 2022 after another three ED visits, revealing an infiltrative uterine mass measuring up to 5.6 cm, which was confirmed by CT abdomen and pelvis to be stage IV uterine adenocarcinoma. Several potential opportunities for intervention were missed in this patient including (1) primary prevention, (2) inadequate physical exam and history acquisition, and (3) delayed diagnostic imaging from the onset of abdominal pain to diagnosis. This case highlights the shortcomings across disciplines in providing early intervention and the disparities of basic patient care in psychiatric patients.

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