June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Chronic central serous chorioretinopathy leading to the diagnosis of Cushing's syndrome
Author Affiliations & Notes
  • Elon Van Dijk
    Leiden University Medical Center, Leiden, Netherlands
  • G Dijkman
    Leiden University Medical Center, Leiden, Netherlands
  • Nienke R Biermasz
    Leiden University Medical Center, Leiden, Netherlands
  • Alberto M Pereira
    Leiden University Medical Center, Leiden, Netherlands
  • Camiel J F Boon
    Leiden University Medical Center, Leiden, Netherlands
  • Footnotes
    Commercial Relationships Elon Van Dijk, None; G Dijkman, None; Nienke R Biermasz, None; Alberto M Pereira, None; Camiel Boon, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 3716. doi:
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      Elon Van Dijk, G Dijkman, Nienke R Biermasz, Alberto M Pereira, Camiel J F Boon; Chronic central serous chorioretinopathy leading to the diagnosis of Cushing's syndrome. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3716.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: We describe three cases of patients who presented with chronic central serous chorioretinopathy (CSC), after which Cushing’s syndrome due to adrenocorticotropin-secreting pituitary adenoma was diagnosed.

Methods: We performed a retrospective review of the charts of three patients. Extensive ophthalmological examination and endocrinological analysis were performed in all patients.

Results: A 49-year-old woman and a 57-year-old man were treated at the Department of Ophthalmology because of bilaterally active, therapy resistant chronic CSC. The most important clinical sign, possibly indicative for Cushing’s syndrome, leading to referral by the ophthalmologist to the endocrinologist, were plethora in the woman and muscle weakness in the man. In a 37-year-old woman known with diabetes mellitus and central obesity, unilaterally active bilateral chronic CSC was diagnosed during endocrinological screening for Cushing’s syndrome. In all three patients endogenous hypercortisolism due to pituitary adenoma was diagnosed after biochemical testing and neuroimaging.<br /> After transsphenoidal resection of the microadenomas in the 49- and the 57-year-old patient, production of morning cortisol could not be detected anymore, and serous subretinal fluid disappeared bilaterally. The 37-year-old patient was scheduled for endoscopic endonasal transsphenoidal surgery. In the meantime, this patient was treated with the oral cortisol synthesis inhibitor metyrapone, which resulted in resolution of serous subretinal fluid in both eyes.

Conclusions: Chronic CSC can be the principal manifestation of oligosymptomatic Cushing’s syndrome. In patients with chronic CSC ophthalmologists should have a high index of suspicion for clinical signs, which can be subtle, of Cushing’s syndrome that warrant endocrinological analysis.

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