Abstract
Cushing's syndrome (CS) shows diverse signs such as centripetal obesity, moon face, and buffalo hump, which can complicate the diagnosis. Facial features including eyelid edema, as an underrecognized sign, can be diagnostic clues for an excess of corticoids in a CS patient.
Keywords: adrenocorticotropin, cortisol, Cushing's sign
Cushing's syndrome (CS) shows diverse signs such as centripetal obesity, moon face, and buffalo hump, which can complicate the diagnosis. Facial features including eyelid edema, as an under‐recognized sign, can be diagnostic clues for an excess of corticoids in a CS patient.
A 49‐year‐old woman presented with amenorrhea and weight gain that had continued for 2 years. Her medical history was dyslipidemia, hypertension, and osteoporosis. Physical examination revealed eyelid edemas (Figure 1A), moon face, buffalo hump, abdominal purple striae, and centripetal obesity (body mass index (BMI), 30.8 kg/m2). Basal plasma adrenocorticotropin was undetectable and serum cortisol level was high (16.9 μg/dl) without circadian rhythms. Free cortisol level in a 24‐h urine collection was elevated (158.7 μg/day). Overnight administration of dexamethasone (1 mg) did not reduce serum cortisol level (17.4 μg/dl). Magnetic resonance imaging suggested bilateral adenomas. We made a diagnosis of adrenal Cushing's syndrome (CS). Since 131l‐adosterol scintigraphy showed specific uptake in the left adrenal gland, left adrenalectomy was laparoscopically performed. Histopathology of the tumor was compatible with adrenocortical adenoma. Three months after surgery, her BMI decreased to 25.0 kg/m2 and eyelid edemas were ameliorated (Figure 1B).
FIGURE 1.
(A) Bilateral eyelid edemas due to Cushing's syndrome are shown. (B) These findings were improved three months after surgery for left adrenal adenomas
Eyelid edema, in addition to centripetal obesity, moon face, and buffalo hump, is also a significant sign of CS; however, it has scarcely been reported in countries other than Japan. 1 , 2 Increased capillary permeability, insufficient venous return due to muscle atrophy, and sodium retention due to mineralocorticoid actions conceivably cause edema in CS.
AUTHORS’ CONTRIBUTIONS
KY wrote the first draft and managed all the submission processes. KO and KH contributed to the clinical management of the patient. FO organized the writing the manuscript.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
ETHICAL APPROVAL
Written informed consent was obtained from the patient to publish this case report.
ACKNOWLEDGMENT
None.
Yamamoto K, Oka K, Hasegawa K, Otsuka F. Eyelid edema due to Cushing's syndrome. Clin Case Rep. 2022;10:e05940. doi: 10.1002/ccr3.5940
Funding information
None
REFERENCES
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