Endocrine Abstracts

Title: Pulmonary Embolism in Surgically Treated Cushing’s Disease: A Case Report

Authors: Qetevan Gvazava1, Nino Zavrashvili1, Natia Margvelashvili2, Natia Shonia2, Ketevan Chanturishvili2 Endocrinology Department, Tbilisi Institute of Medicine

Background: Cushing’s disease is the most common cause of Cushing’s syndrome but can be very difficult to diagnose and to treat. as we know it has numerous health effects on patients and long-term health and quality of life in these patients often remains suboptimal, despite treatment. patients with CS have about ten times the risk for VTE. 2019 meta-analysis encompassed 7142 patients with endogenous CS (including Cushing’s disease) undergoing transsphenoidal surgery or adrenalectomy, and their risk of unprovoked VTE was almost 18 times higher in comparison with a healthy population. The aim of this case report is to underline the clinical significance of increased VTE in endogenous Cushing’s syndrome and to keep high clinical suspicion after undergoing transsphenoidal surgery.

Case Description: We report 57 years old women, who was hospitalized in our hospital with declining health for 6 months. Patient complained of weight gain, discomfort in chest area, face and neck edema, muscle weakness and overall low energy. Upon physical examination and appropriate laboratory work-up, this patient was diagnosed with ACTH dependent Cushing’s syndrome. Head MRI later confirmed Cushing’s disease and patient was set up for transsphenoidal surgery for removal of pituitary adenoma. Few weeks post-op patient presented in ER with tachycardia, shortness of breath, chest pain. PE was diagnosed and patient was started on anticoagulative therapy, oxygen therapy and close monitoring. It also needs to be mentioned that the patient had a history of hypertension and valve replacement, as well as Covid-19 disease.

Conclusion: In conclusion we want to highlight that CS is a risk factor for VTE/PE, which is often overlooked. It is important to keep high clinical suspicion and continue close monitoring of CS patients even after transsphenoidal surgery treatment. Physicians who treat VTE/PE cases should also be aware of increased risk associated with Cushing’s disease.