Endocrine Abstracts

Cardiovascular disease and diastolic hypertension are major causes of morbidity in Cushing’s although left ventricular failure is more rarely described. There are three other cases of documented dilated cardiomyopathy with subsequent left ventricular failure.

Thirty-five year old lady who presented with obesity and striae was found to have a suppressed ACTH, elevated cortisol (914 post dexamethasone suppression test) and a right adrenal adenoma (on CT), confirming a diagnosis of Cushing’s syndrome. She was started on metyrapone 250 mg TDS and was referred for a right adrenalectomy. During the next 2 months, she was admitted to hospital with acute dyspneoa. Her CT pulmonary angiogram revealed no pulmonary embolus. She was discharged on oral antibiotics for a chest infection. She was readmitted a week later with left ventricular failure (LVF) and type 1 respiratory failure requiring high flow oxygen and diuretics. She clinically had moderate mitral regurgitation confirmed on echocardiogram, which also suggested a diagnosis of dilated cardiomyopathy with severe LVF (ejection fraction – EF 26%). Her cardiomyopthay screen (autoantibodies, virology and thyroid) was negative but her cortisol day curve had values over a thousand suggesting a steroid induced cardiomyopathy. She gradually responded well to doubling of her metyrapone to 500 mg TDS and supportive care in the form of oxygen, ACE inhibition, beta blockade and diuretics. She had an angiogram a month later that ruled out any ischaemic causes for her cardiomyopathy and showed an improving LVEF of 40%. She had her adrenalectomy (right) 3 months later. This revealed a benign cortical adenoma (55×45×28 mm). Her post operative echocardiogram showed an EF of more than 45% and her 3 month post operative echo showed reversal of her cardiomyopathy.

Monotherapy (metyrapone blockade) of her Cushing’s with subsequent curative surgery resulted in reversal of her cardiomyopathy which would have otherwise had a significant effect on her morbidity.