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Arterial thrombosis as primary presentation of endogenous Cushing's syndrome

Vijay Alexander1, Maria Koshy1, Riddhi Dasgupta2

  • 1Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India.

BMJ Case Reports
|February 9, 2019
PubMed

Insights

Cushing's syndrome can cause dangerous blood clots, a condition often overlooked. This case highlights the importance of recognizing hypercoagulability in Cushing's syndrome for timely diagnosis and treatment.

Area of Science:

  • Endocrinology
  • Hematology

Background:

  • Cushing's syndrome (CS) is characterized by prolonged exposure to excess cortisol.
  • While well-documented, hypercoagulability is an under-recognized complication of CS.

Observation:

  • A 31-year-old woman presented with fever, abdominal pain, and dyspnea.
  • Clinical and biochemical findings confirmed endogenous ACTH-dependent CS.
  • Abdominal imaging revealed splenic collection, empyema, and extensive arterial thrombosis.

Findings:

  • Despite negative pituitary MRI and ectopic source imaging (Ga-68 DOTATATE PET CT), a diagnosis of endogenous CS with a prothrombotic state was established.
  • The patient exhibited severe arterial thrombosis, a critical manifestation.

Implications:

  • This case underscores the necessity of screening for hypercoagulability in patients with Cushing's syndrome.
  • Early detection and management of thrombotic complications are crucial for improving patient outcomes.
  • Bilateral adrenalectomy proved effective in managing the condition.

Keywords:
medical managementpituitary disordersvenous thromboembolism

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