Endocrine Abstracts

Key words- Cushing’ Disease, Aortic Dissection

Background: Cushing’s syndrome is a rare endocrine disorder. It is frequently presented with obesity, type 2 diabetes, or hypertension with an increased cardiovascular risk. The association of Cushing’s syndrome with aortic dissection is rare. We report a young man who presented with hypertensive emergency and aortic dissection. He was later found to have Cushing’s disease.

Case report: A 42-year-old male presented to the GP with stage 3 hypertension and was started on antihypertensive. Two months later, he presented with severe chest pain and noted to have differential blood pressure on arms. The CT angiogram showed Type A dissection of the Ascending aorta. He underwent urgent surgical repair of the dissection. As he had Cushingoid features, he was referred to Endocrinology. His BMI was 29.2 kg/m2 and had typical features of Cushing’s Syndrome. He had a non-suppressed overnight dexamethasone suppression test (Cortisol 91 nmol/l), high 24-h urine cortisol (368 nmol/24h), and a non-suppressed low dose of Dexamethasone suppression test (cortisol 196 nmol/l). The ACTH measurement of 52ng/l confirmed ACTH dependant Cushing’s. MRI pituitary showed a microadenoma measuring 6mm, confirming the diagnosis of Cushing’s disease. He was diagnosed with osteoporosis. His glucose tolerance test was normal. He is awaiting further management.

Conclusion: Aortic dissection is a rare cardiovascular manifestation of Cushing’s syndrome with high mortality. A high index of suspicion for secondary hypertension in a young person with high blood pressure is required. Early detection of Cushing’s syndrome is the key to reduce the cardiovascular and metabolic risks associated with the disease.