Hypertensive encephalopathy as the initial manifestation of Cushing’s syndrome

Abstract

A 65-year old lady was rushed into the accident and emergency department with a two-day history sudden onset severe generalized throbbing headache associated with restlessness, irritability, irrational talk, projectile vomiting and loss of consciousness of three hours duration. On examination, she had moon face, buffalo hump, and truncal obesity with body mass index was 45.84kg/m2 . Her blood pressure was 190/120 mmHg. Serum cortisol done at 0800 hrs the next day was elevated with a value of 511 ng/ml. 1 mg overnight dexamethasone was 148 ng/ml. The diagnosis of hypertension secondary to Cushing’s syndrome should be strongly considered in any hypertensive obese patients regardless of age with typical ‘cushingoid facies’. An assessment of serum cortisol in such patients would be beneficial in diagnosing this condition and optimizing treatment outcomes.