CENTRAL SEROUS CHORIORETINOPATHY (CSCR)

AN UNCOMMON MANIFESTATION OF CUSHING’S SYNDROME

Abstract

INTRODUCTION/BACKGROUND
Central serous chorioretinopathy (CSCR) has been identified as a rare clinical presentation linked to elevated cortisol levels, both in overt Cushing’s syndrome and in subclinical cases of hypercortisolism. We report a case of Cushing’s syndrome with uncommon presentation.

CASE
A 42- year-old female with pre-existing diabetes mellitus, hypertension and class III obesity came to the ophthalmology clinic for blurring of vision. Upon presentation, her blood pressure was 198/100 mm Hg and her blood glucose was 20 mmol/L. She was therefore admitted due to hypertensive emergency and uncontrolled diabetes mellitus. As the patient exhibited stigmata of Cushing’s syndrome, further investigations revealed unsuppressed serum cortisol level after an overnight low dose (1mg) dexamethasone suppression test (ODST), elevated 24- hour urinary cortisol 1912 nmol/24hours, elevated plasma adrenocorticotrophic hormone (ACTH): 14.8 pmol/L, elevated serum dehydroepiandrosterone sulphate (DHEAS): >27 umol/L and elevated serum testosterone: 5.59 nmol/L. Eye assessment with fundoscopy and optical coherence tomography was suggestive of CSCR. Magnetic resonance imaging (MRI) revealed a left lateral pituitary microadenoma. She was treated with steroidlowering therapy and scheduled for eye laser treatment by a retina surgeon.

CONCLUSION
When CSCR is diagnosed, it is important to consider a work-up for Cushing’s syndrome due to the association between high cortisol levels and CSCR. Laser therapy is one of the treatment options for CSCR while addressing the underlying cause.