ECEESPE2025 ePoster Presentations Pituitary, Neuroendocrinology and Puberty (220 abstracts)
Cushing’s disease and severe resistant hypertension: surgical challenges due to rare kissing carotids
Baltagi Myriam 1 , Ibtissem Ben Nacef 1 , Rihab Laamouri 1 , Sabrine Mekni 1 , Sawsen Essayeh 1 , Rojbi Imen 1 & Khiari Karima 1
1Hospital of Charles Nicolle, Tunis, Tunisia.
JOINT1902
Background: A 44-year-old male (BM) was referred for severe, resistant hypertension managed with quadritherapy since age 41. Clinical evaluation revealed hypokalemia, facial plethora, adiposity with a rounded facial appearance, and lower limb muscle atrophy, raising suspicion of hypercortisolism.
Case Presentation: Biochemical investigations confirmed ACTH-dependent Cushing’s disease with elevated ACTH levels (>20 pg/ml) and cortisol non-suppression on the dexamethasone suppression test. Pituitary MRI identified a microadenoma associated with "kissing carotids," a rare vascular anomaly characterized by the medialization of the internal carotid arteries. This malformation significantly increased the risk of vascular injury during transsphenoidal surgery, the standard treatment for Cushing’s disease.
Management Challenges: The rare association of a pituitary microadenoma with "kissing carotids" complicated the surgical approach, necessitating multidisciplinary planning. Alternative therapies considered included medical management with steroidogenesis inhibitors, stereotactic radiosurgery, or bilateral adrenalectomy to control hypercortisolism.
Conclusion: This case illustrates the complexities of managing Cushing’s disease in the presence of "kissing carotids," a rare but clinically significant vascular anomaly. Multidisciplinary collaboration and individualized treatment planning are essential to optimize safety and outcomes in such challenging scenarios.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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