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Acute severe Cushing's disease presenting as a hypercoagulable state

Maria Mohammed Fariduddin1, Wajihuddin Syed1, Vidita Divan1

  • 1State University of New York Upstate Medical University, Syracuse, New York.

Proceedings (Baylor University. Medical Center)
|November 4, 2021
PubMed

Insights

Cushing's disease, a condition causing excess cortisol, can lead to severe symptoms like blood clots and bone fractures. Early diagnosis is crucial for managing this pituitary disorder.

Area of Science:

  • Endocrinology
  • Internal Medicine
  • Oncology

Background:

  • Cushing's disease (CD) is the primary cause of endogenous cortisol excess.
  • It results from a pituitary adenoma secreting excess adrenocorticotropic hormone (ACTH).
  • CD can manifest with diverse clinical features, impacting multiple organ systems.

Observation:

  • A 60-year-old woman presented with recurrent venous thromboembolism, refractory hypokalemia, and lumbar compression fractures.
  • Her disease course was rapidly progressive, suggesting an aggressive underlying pathology.
  • Ectopic hypercortisolism was initially suspected due to her age and acute symptom onset.

Findings:

  • Investigations confirmed cortisol excess originating from a pituitary microadenoma.
  • The patient's severe presentation included significant thromboembolic events and skeletal complications.
  • This confirmed a diagnosis of Cushing's disease, not ectopic ACTH syndrome.

Implications:

  • Cushing's disease can present with severe, life-threatening complications.
  • Hypercortisolism, particularly in CD, significantly elevates the risk of venous thromboembolism.
  • This case underscores the importance of considering CD in patients with unexplained hypercortisolism and thrombotic events.

Keywords:
CortisolCushing’s diseasefracturehypercoagulabilitythromboembolism

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