Case Report

A Case of Cushing’s Syndrome Presented with Severe Heart Failure and Multiple Vertebral Fractures


  • Ayşe Arduç
  • Serhat Işık
  • Gülhan Akbaba
  • Kerim Küçükler
  • Dilek Berker
  • Serdar Güler

Received Date: 14.02.2015 Accepted Date: 15.03.2015 Med Bull Haseki 2015;53(3):256-259

Cushing’s syndrome (CS) is associated with increased morbidity and mortality due to cardiovascular diseases and osteoporosis. Clinical findings and mortality are related to degree and duration of hypercortisolism. We report a patient with CS who presented with severe complications resulting from delayed diagnosis. A 52-year-old male with a two-year history of uncontrolled diabetes mellitus and hypertension and a six-month history of heart failure was admitted with leg edema, dyspnea, and back pain. His physical examination revealed plethora, abdominal obesity, and abdominal purple striae. Laboratory analysis revealed the following results: adrenocorticotropic hormone: <5 pg/ml, morning plasma cortisol: 26.33 µg/dl, night plasma cortisol: 26.38 µg/dl, and urine cortisol: 272 µg/24 hour. No suppression was detected in the plasma cortisol of 2 mg and 8 mg dexamethasone suppression tests (30.7 µg/dl and 35.54 µg/dl, respectively). Echocardiography showed low ejection fraction (40%), X-ray demonstrated vertebral fractures. Adrenal CT revealed a 4x4 cm left adrenal mass. The patient underwent left adrenalectomy. Histopathological diagnosis was adrenocortical adenoma. After the operation, a partial recovery was detected in his diabetes mellitus, hypertension, and osteoporosis. An operation was planned for vertebral fractures. Clinicians should keep in mind the presence of CS when diabetes and hypertension are more severe and treatment-resistant. A delay in diagnosis can lead to serious complications that can result in death.

Keywords: Cushing’s syndrome, heart failure, vertebral fracture

Full Text (Turkish)