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