Cushing's syndrome diagnosed incidentally on CT imaging

Area of Science:

• Endocrinology
• Radiology
• Internal Medicine

Background:

• Cushing's syndrome is a complex endocrine disorder with varied clinical manifestations.
• Adrenocorticotropic hormone-independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of Cushing's syndrome.
• Hypercoagulable states can present with unusual thrombotic events.

Observation:

• An elderly patient presented with chest pain, hypertension, and hyperglycemia.
• Imaging revealed splenic artery thrombosis, infarcts, and adrenal hyperplasia.
• Clinical features included gynecomastia and centripetal fat distribution.

Findings:

• Adrenocorticotropic hormone-independent macronodular adrenal hyperplasia was identified as the underlying cause.
• The endocrine disorder was linked to the patient's hypercoagulable status.
• Endocrinological investigations confirmed the diagnosis.

Implications:

• This case underscores the importance of considering endocrine disorders in undifferentiated patients with atypical presentations.
• Effective communication between clinicians and radiologists is crucial for accurate diagnosis.
• Recognizing rare etiologies like AIMAH can unify complex clinical and imaging findings.