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A Case of Acute Aortic Dissection Type B Associated with Cushing's Syndrome

Luigi Petramala1, Dario Cotesta, Paolo Sapienza

  • 1Day Hospital of Internal Medicine and Hypertension-Department of Clinical Science University "Sapienza", Rome, Italy.

Journal of Clinical Medicine Research
|April 17, 2012
PubMed

Insights

This case study highlights a rare association between acute aortic dissection type B and Cushing's syndrome. The patient presented with chest pain and was incidentally found to have an adrenal tumor causing Cushing's syndrome.

Area of Science:

  • Cardiology
  • Endocrinology
  • Surgical Case Report

Background:

  • Cushing's syndrome is a disorder caused by prolonged exposure to high cortisol levels.
  • Aortic dissection type B (Stanford B, DeBakey III) involves the descending aorta.
  • Adrenocortical adenomas are the most common cause of endogenous Cushing's syndrome.

Observation:

  • A 63-year-old male with hypertension and obesity presented with severe chest pain and dyspnea, initially suspected as acute aortic dissection.
  • CT imaging revealed a Stanford B aortic dissection extending from the left subclavian artery to the left renal artery.
  • An incidental 25 mm left adrenal tumor was discovered, later diagnosed as a cortisol-producing adenoma causing Cushing's syndrome.

Findings:

  • The patient underwent emergent surgical repair of the aortic dissection with a prosthetic graft.
  • Subsequent evaluation confirmed increased cortisol production, leading to a diagnosis of Cushing's syndrome.
  • The patient successfully underwent laparoscopic adrenalectomy for the adrenal tumor.

Implications:

  • This case underscores the importance of thorough diagnostic evaluation in patients with complex presentations.
  • The co-occurrence of aortic dissection type B and Cushing's syndrome, while rare, warrants consideration in clinical practice.
  • Management requires a multidisciplinary approach involving cardiothoracic surgery, endocrinology, and potentially general surgery.
Abstract

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