{"title":"Secondary Ocular Hypertension with Exophthalmos as the First Presentation of Endogenous Cushing's Syndrome.","authors":"Thanatporn Threetong, Sasikant Leelawongs","doi":"10.1159/000546434","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Cushing's syndrome results from excessive exposure to exogenous or endogenous steroid, while cushing's disease is hypercortisolism from an adrenocorticotropic hormone-secreting pituitary adenoma. Secondary ocular hypertension (OHT) accompanied by exophthalmos as the initial presentation of endogenous Cushing's syndrome has rarely been reported.</p><p><strong>Case presentation: </strong>A 46-year-old Thai woman was referred for OHT treatment despite maximum tolerance to medication. Intraocular pressure (IOP) was 21 mm Hg (right eye) and 25 mm Hg (left eye). Visual acuity was 20/20 in both eyes. Bilateral eyelids were swollen without any palpable masses. Exophthalmometer measurements were 24 mm (right eye) and 23 mm (left eye). Extraocular muscle movements, anterior segment, gonioscopy, and dilated fundoscopic exams were normal bilaterally. Optic nerve head was unremarkable in both eyes. Optical coherence tomography showed marginal inferior thinning of the retinal nerve fiber layer and ganglion cell layer in left eye. Computerized visual field 24-2 was normal bilaterally. She was diagnosed with secondary OHT with exophthalmos in both eyes. Thyroid function and thyroid antibody tests were unremarkable. Orbital and brain computed tomography revealed exophthalmos with an increase of retrobulbar fat bilaterally and a hypodense pituitary lesion. She was diagnosed with Cushing's disease and underwent endoscopic transsphenoidal adenectomy. At 6-month postoperatively, IOP decreased to 16 mm Hg (right eye) and 17 mm Hg (left eye), without any IOP-lowering medications. Exophthalmos also improved as exophthalmometer measurements were 20 mm (right eye) and 19 mm (left eye).</p><p><strong>Conclusions: </strong>Endogenous Cushing's syndrome should be included in the differential diagnosis of secondary OHT with exophthalmos.</p>","PeriodicalId":9635,"journal":{"name":"Case Reports in Ophthalmology","volume":"16 1","pages":"439-445"},"PeriodicalIF":0.6000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180786/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Case Reports in Ophthalmology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000546434","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
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Abstract
Introduction: Cushing's syndrome results from excessive exposure to exogenous or endogenous steroid, while cushing's disease is hypercortisolism from an adrenocorticotropic hormone-secreting pituitary adenoma. Secondary ocular hypertension (OHT) accompanied by exophthalmos as the initial presentation of endogenous Cushing's syndrome has rarely been reported.
Case presentation: A 46-year-old Thai woman was referred for OHT treatment despite maximum tolerance to medication. Intraocular pressure (IOP) was 21 mm Hg (right eye) and 25 mm Hg (left eye). Visual acuity was 20/20 in both eyes. Bilateral eyelids were swollen without any palpable masses. Exophthalmometer measurements were 24 mm (right eye) and 23 mm (left eye). Extraocular muscle movements, anterior segment, gonioscopy, and dilated fundoscopic exams were normal bilaterally. Optic nerve head was unremarkable in both eyes. Optical coherence tomography showed marginal inferior thinning of the retinal nerve fiber layer and ganglion cell layer in left eye. Computerized visual field 24-2 was normal bilaterally. She was diagnosed with secondary OHT with exophthalmos in both eyes. Thyroid function and thyroid antibody tests were unremarkable. Orbital and brain computed tomography revealed exophthalmos with an increase of retrobulbar fat bilaterally and a hypodense pituitary lesion. She was diagnosed with Cushing's disease and underwent endoscopic transsphenoidal adenectomy. At 6-month postoperatively, IOP decreased to 16 mm Hg (right eye) and 17 mm Hg (left eye), without any IOP-lowering medications. Exophthalmos also improved as exophthalmometer measurements were 20 mm (right eye) and 19 mm (left eye).
Conclusions: Endogenous Cushing's syndrome should be included in the differential diagnosis of secondary OHT with exophthalmos.
简介：库欣综合征是由于过度暴露于外源性或内源性类固醇引起的，而库欣病是由促肾上腺皮质激素分泌的垂体腺瘤引起的高皮质醇症。继发性高眼压（OHT）伴随眼球突出作为内源性库欣综合征的最初表现很少被报道。病例介绍：一名46岁的泰国妇女被推荐接受OHT治疗，尽管对药物有最大的耐受性。眼内压（IOP）右眼21 mm Hg，左眼25 mm Hg。双眼视力均为20/20。双侧眼睑肿胀，未见肿块。突出眼计测量值分别为右眼24 mm和左眼23 mm。眼外肌运动、眼前节、角镜检查和眼底扩张镜检查均正常。双眼视神经头未见明显变化。光学相干断层扫描显示左眼视网膜神经纤维层和神经节细胞层边缘下变薄。计算机视野24-2双侧正常。她被诊断为继发性OHT，双眼突出。甲状腺功能及甲状腺抗体检查无明显差异。眼眶和脑部计算机断层显示眼球突出，双侧球后脂肪增加，垂体低密度病变。她被诊断为库欣病，并接受了内窥镜经蝶窦腺切除术。术后6个月，在没有任何降眼压药物的情况下，IOP分别降至右眼16 mm Hg和左眼17 mm Hg。当凸眼计测量值分别为20 mm（右眼）和19 mm（左眼）时，凸眼也得到改善。结论：内源性库欣综合征应纳入继发性OHT伴突出眼的鉴别诊断。
期刊介绍：
This peer-reviewed online-only journal publishes original case reports covering the entire spectrum of ophthalmology, including prevention, diagnosis, treatment, toxicities of therapy, supportive care, quality-of-life, and survivorship issues. The submission of negative results is strongly encouraged. The journal will also accept case reports dealing with the use of novel technologies, both in the arena of diagnosis and treatment. Supplementary material is welcomed. The intent of the journal is to provide clinicians and researchers with a tool to disseminate their personal experiences to a wider public as well as to review interesting cases encountered by colleagues all over the world. Universally used terms can be searched across the entire growing collection of case reports, further facilitating the retrieval of specific information. Following the open access principle, the entire contents can be retrieved at no charge, guaranteeing easy access to this valuable source of anecdotal information at all times.
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