Case Report: Cushings SyndromePresenting as Hypertensive Emergency with Acute Pulmonary Odema

A 22 Year old obese woman presented to emergency medicine department in severe respiratory distress. It was sudden in onset, progressive & associated with cough with pinkish frothy sputum. Her vitals on arrival to ER were BP of 190/130 mmHg, HR of 136 bpm, RR of 34 cpm, SpO2 of 72% on room air. On examination, there were diffuse fine end inspiratory crepitations bilaterally with severe respiratory distress. Patient was immediately treated for hypertensive emergency with pulmonary odema with intravenous Furosemide, IV Nitroglycerin, Oxygen therapy with NIV CPAP. Upon further evaluation in the observation unit, it was found that the patient was also having hyperglycemia, hypocalcemia, hypokalemia, metabolic alkalosis, obesity, purple striae over the abdomen, with irregular menstrual cycles. A screening test of overnight dexamethasone suppression test was done and found serum cortisol to be significantly elevated (51.49 μg/dL), confirming the diagnosis of cushings syndrome presenting with hypertensive emergency and acute pulmonary odema. Background Hypertension (HTN) is an important but largely treatable risk factor for cardiovascular disease that affects almost one-third of Americans and approximately 1 billion people worldwide [1,2]. Hypertensive emergency a disease state defined by acute TOD (target organ damage), manifest by newly developed clinical sequelae or diagnostic test abnormalities. A hypertensive emergency can exist in patients with or without underlying chronic HTN [3]. This is a rare case of cushings syndrome presenting to emergency with hypertensive crisis and acute pulmonary odema requiring non invasive ventilator support and intravenous antihypertensives for stabilization.