Exophthalmos Revealing Cushing’s Syndrome: A Case Report

Abstract

Exophthalmos is typically associated with Graves’ ophthalmopathy. Although originally described by Harvey Cushing, exophthalmos is an underappreciated sign of Cushing’s syndrome. We present a case of a patient aged 40 years with no pathological history presenting with generalized asthenia associated with weight loss of 15kg for 2 months, epigastralgia and incoercible vomiting. Clinical examination revealed a normotensive, normocardiac patient with pain on epigastric palpation, bilateral exophthalmos, and an unremarkable cervical examination No cushingoid syndrome especially no facial erythrosis, no purple stretch marks, no buffalo hump, no amyotrophy of the lower limbs. An abdominal CT scan performed before the abdominal pain revealed an adrenal incidentaloma, a right adrenal nodule, well limited, of low density, homogeneous, very discreetly and homogeneously enhanced after injection of contrast medium, whose hemodynamic behavior was in favor of a benign adenoma. The patient underwent surgery for right adrenalectomy, with morphological and immunohistochemical findings in favour of adrenocortical carcinoma, with clinical and biological improvement. We discuss the possible mechanisms causing exophthalmos in patients with either endogenous or exogenous hypercortisolemia.