Cerebral Venous Sinus Thrombosis After Transsphenoidal Resection: A Rare Complication of Cushing Disease-Associated...

Venous thromboembolism is a well-known complication of Cushing syndrome. Deep vein thrombosis and pulmonary embolic events have been widely reported in patients with Cushing syndrome, but cerebral venous sinus thrombosis remains a much less common finding in these patients.

We report one of the first cases of cerebral venous sinus thrombosis in a patient with Cushing disease. An 18-year-old man presented to our clinic with accelerated weight gain despite an active lifestyle and unchanged diet. Workup revealed adrenocorticotrophic hormone-dependent hypercortisolism, and magnetic resonance imaging demonstrated a 6-mm pituitary microadenoma, consistent with Cushing disease. He underwent endoscopic transsphenoidal resection and achieved the desired postoperative adrenal insufficiency. The patient was discharged home, but presented again in a delayed fashion with profound cerebral venous sinus thrombosis requiring a prolonged hospitalization.

Previous studies have suggested that the coagulation profile of patients with Cushing syndrome normalizes when measured 12 months after correction of hypercortisolism, but these patients may remain hypercoagulable for an undefined period postoperatively, despite becoming adrenally insufficient. Although there have been scarce reports of cerebral venous sinus thrombosis in non-adrenocorticotrophic hormone-dependent Cushing syndrome, we report the first case of cerebral venous sinus thrombosis postoperatively in a patient with Cushing disease in remission.