Endocrine Abstracts

Introduction: The hypercortisolaemic state of Cushing’s syndrome can lead to ophthalmic complications. We present two case reports of rare association of central serous retinopathy (CSR) and Cushing’s syndrome.

Case 1: A 46-year-old man presented with gradual deteriorating vision. He was diagnosed with CSR and was referred to the Endocrine department for screening for Cushing’s given suspicious clinical features. Past history included hypertension and type 2 diabetes mellitus. On examination, he had increased nuchal fat pad, centripetal obesity and truncal striae. Cushing’s syndrome was confirmed biochemically with elevated 24-hour urine free cortisols: 278, 335 and 436 nmol/l (Normal<165); unsuppressed 9 am cortisol in dexamethasone suppression test (128 nmol/l: Normal<50) and elevated midnight salivary cortisol (2.9 nmol/l; normal<1.7). CRH testing, MRI (pituitary micro-adenoma) and petrosal sinus sampling was consistent with ACTH dependent Cushing’s disease. Biochemical and clinical remission was achieved following transphenoidal hypophysectomy in December 2020.

Case 2: 43-year-old man presented with vision loss and was diagnosed with central serous retinopathy. In addition he had clinical features of plethoric facies, easy bruising, thinning of the skin, hypertension and central obesity. He had raised urinary free cortisol (1292), elevated dexamethasone post low dose dexamethasone suppression test. He underwent a transphenoidal hypophsectomy and had full biochemical and clinical remission post operatively. His CSR is currently in remission.

Discussion: In CSR the choroid layer in the retina is thickened and congested with increased blood vessels, resulting in increased pressure which can cause capillary damage to the retina. Excess steroids is the greatest risk factor for CSR. Treatment for Cushing’s along with specific ophthalmic treatment for CSR can potentially reverse the disease and protect sight.

Learning points: 1. Cushing’s syndrome is a diagnosis to consider in patients with CSR and no history of steroid use. 2. Treatment of Cushing’s syndrome can potentially be sight preserving.