Subclinical hypercortisolism in central serous chorioretinopathy

To describe a case of a patient with chronic central serous chorioretinopathy who was found to have an adrenocorticotropin-secreting pituitary microadenoma despite the absence of many clinical signs of Cushing syndrome.

A retrospective chart review was performed. This study included a 42-year-old white woman with a history of chronic central serous chorioretinopathy.

The patient was found to have severe osteoporosis; although many of the classic signs of Cushing syndrome were absent, laboratory studies and neuroimaging suggested the presence of a pituitary microadenoma. Ophthalmic evaluation revealed the presence of bilateral submacular fluid because of chronic multifocal central serous chorioretinopathy. The patient underwent bilateral photodynamic therapy and surgical excision of the pituitary lesion. Pathologic evaluation confirmed that the pituitary lesion was a pituitary microadenoma.

Careful attention to the signs of hypercortisolism in patients with central serous chorioretinopathy may aid in detecting underlying systemic pathology. Endocrinology evaluations in patients presenting with any manifestations of Cushing syndrome may be warranted, even if many classic physical findings are absent.