Secondary mania is still an under-recognized pathology even if nowadays psychiatrist benefit from a wide range of imagistic and laboratory tools. The following case study illustrates bipolar affective disorder, manic episode with psychotic symptoms in a 36 years old female which had an abrupt beginning. At the moment of examination in the office at the medical centre she presented tachypsychia, grandiosity and interpretative delusions, positive hyperthymia, sterile hyperactivity, elevated appetency, hyperbulia, low sleep need.

The importance of having in mind the 5 most frequent causes of mania caused by generalized medical condition when presented with an atypical manic episode.

Our aim is to increase the acknowledgement of a more elaborate paraclinic approach for psychiatrists whom find themselves in front of bipolar disease case that also have somatic issues attached.

For this type of cases the laboratory and imagistic exploration are the key to an accurate diagnosis and therefore for an aimed treatment. In our case the imagistic exploration and blood tests revealed a well defined tumor in the left suprarenal gland.

The psychiatric diagnosis was bipolar affective mood disorder due to a general medical condition and the patient was transferred to the Endocrinology Clinic.

After the surgery of the tumor both the psychiatric symptoms and the secondary Cushing syndrome disappeared completely.