Endocrine Abstracts (2006) 11 P79

Ophthalmic presentations of Cushing’s syndrome

IM Ibrahim1, A Al-Bermani2 & RA James1

1Endocrine unit, Royal Victoria Infirmary, Newcastle-upon Tyne, United Kingdom; 2Department of Ophthalmology, Royal Victoria Infirmary, Newcastle-upon Tyne, United Kingdom.

Introduction: Central Serous Retinopathy (CSR) is a condition characterized by the accumulation of sub-retinal fluid at the posterior pole of the fundus, creating a circumscribed area of serous retinal detachment. It is associated with increased levels of endogenous or exogenous glucocorticoids and has been described in patients with Cushing’s syndrome (CS).

Here we report on two cases we recently managed in our unit, with central serous retinopathy and Cushing’s syndrome.

Case 1: 40-year-old male referred by the ophthalmology service with visual failure on background of central serous retinopathy. MRI of the pituitary revealed the presence of a large pituitary macro adenoma with optic chiasm compression and involvement of the cavernous sinus. Endocrine investigations confirmed Cushing’s disease with 9:00 am ACTH greater than 1000. He had Trans-sphenoidal decompression surgery, which made an impact on his visual acuity, and his ACTH has declined to 360. He is awaiting further management for his CS.

Case 2: 39-year-old male diagnosed with bilateral CRS in 1999 for which he had laser treatment to the left eye. The patient conducted his own literature search on the Internet and found an association between CRS & CS and insisted that his GP screened him for CS to account for some of his symptoms. Although he didn’t have florid features of CS, endocrine assessment including IPSS confirmed a pituitary micro adenoma causing Cushing’s disease. He subsequently underwent Trans-sphenoidal surgery, which cured his Cushing’s disease.

Conclusion: These cases give additional evidence that glucocorticoids may play a role in the pathogenesis of CSR and patients presenting with this ophthalmic problem should be questioned for features of Cushing’s syndrome.

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