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Chronic central serous chorioretinopathy as a presenting symptom of Cushing syndrome

Abstract

Purpose

To describe 4 patients who were diagnosed with chronic central serous chorioretinopathy (cCSC), which appeared to be the presenting symptom of Cushing syndrome (CS).

Methods

In this retrospective review of charts, all patients received extensive ophthalmologic examination and endocrinologic analyses.

Results

A 56-year-old man and a 49-year-old woman were treated because of bilaterally active, therapy-resistant cCSC. The clinical sign indicative for CS leading to referral to the endocrinologist was muscle weakness in the man and plethora in the woman. In a 37-year-old woman with known diabetes mellitus and central obesity, bilateral cCSC was diagnosed before CS screening. Another 49-year-old woman was treated for unilateral cCSC for 4 years. Complaints of fatigue, muscle weakness, central adiposity, and skin atrophy led to referral and a CS diagnosis due to bilateral macronodular adrenal hyperplasia. In all patients, CS surgery resulted in complete resolution of subretinal fluid. During postsurgical follow-up, no reactivation of cCSC was observed.

Conclusions

Chronic CSC can be the principal manifestation of relatively mildly symptomatic and unrecognized CS. In patients with cCSC, ophthalmologists should have a high index of suspicion for clinical signs of CS that warrant endocrinologic analysis. Cushing syndrome surgery can stop active subretinal fluid leakage in cCSC.

Eur J Ophthalmol 2016; 26(5): 442 - 448

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/ejo.5000790

Authors

Elon H.C. van Dijk, Greet Dijkman, Nienke R. Biermasz, Femke M. van Haalen, Alberto M. Pereira, Camiel J.F. Boon

Article History

Disclosures

Financial support: Supported by the following foundations: MaculaVereniging, Landelijke Stichting voor Blinden en Slechtzienden, Retina Netherlands, and BlindenPenning, which contributed through UitZicht. The funding organizations had no role in the design or conduct of this research. They provided unrestricted grants.
Conflict of interest: None of the authors has conflict of interest with this submission.

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Authors

Affiliations

  • Department of Ophthalmology, Leiden University Medical Center, Leiden - The Netherlands
  • Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, Leiden University Medical Center, Leiden - The Netherlands

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