Endocrine Abstracts

Cushing’s syndrome is a rare disease with an incidence of 0.72–2.4/million per year. Approximately 14% of patients are over 60 years of age but <1% are over 80 years of age. In a 2-month period, we diagnosed three females over 80 years of age as having Cushing’s syndrome. None of them had a typical cushingoid appearance.

Patient 1, 80 years of age. Presentation: coincidental finding of bilateral adrenal hypertrophy on CT scanning as part of investigations for weight loss. No evidence of malignancy was found. Clinical features: hypertension, skin changes (previously attributed to treatment with inhaled and oral glucocorticoids). Co-morbidities: severe chronic obstructive pulmonary disease. Investigations: biochemical and imaging evidence confirmed a diagnosis of Cushing’s disease.

Patient 2, 80 years of age. Presentation/clinical features: hypertension, peripheral oedema, and hypokalemia. Co-morbidities: none. Investigations: metastatic adrenocortical carcinoma with biochemical evidence of tumour secretion of cortisol and aldosterone confirmed.

Patient 3, 81 years of age. Presentation/clinical features: presented to acute medical unit with hypertension and dyspnoea. Recent diagnosis of type 2 diabetes. Proximal myopathy found on examination. Co-morbidities: severe aortic stenosis and stage 3 chronic kidney disease. Investigations: biochemical and imaging evidence confirmed Cushing’s disease.

It is very unusual to diagnose three octogenarians with Cushing’s syndrome in such a short period of time. All 3 patients had capacity to be involved in the decisions made on their management. Patient 1 was deemed too frail for any treatment other than symptomatic. Patient 2 declined treatment other than spironolactone. Patient 3, metyrapone treatment being considered.

When the rare diagnosis of Cushing’s syndrome is made in elderly patients the aetiology and co-morbidities make treatment very difficult. The decisions made on treatment in these three patients was helped by their ability to contribute to the process.