PS-R02-2: HEART FAILURE AS A PRESENTING FEATURE OF CUSHING'S DISEASE: A CASE REPORT

Abstract

Cushing's disease is an endocrine disorder in which the pituitary gland releases too much adrenocorticotropic hormone, resulting in excess synthesis and secretion of cortisol by the adrenal glands. Cushing's disease associated heart failure is rare in clinic and can be misdiagnosed with initial presentation of heart failure. Symptoms of heart failure are caused by structural and functional alterations in the heart. The disturbances of cardiac structure and function may be recovered by eucortisolaemia. A 30-year-old man with a medical past of hypertension and history of smoking presented to the outpatient department with global heart failure. The left ventricular ejection fraction (LVEF) was estimated as 31% and the blood pressure (BP) was above 180/100 mmHg. After 1 months of optimal pharmacological treatment for systolic heart failure, there was obvious improvement of LVEF of 42%. Clinical features were suspicious for Cushing's disease. Initially, the patient could not have an MRI because of metal sheet in the body. After removal of metal sheet, the pituitary imaging were suggestive of Cushing's disease. The patient was referred to the neurosurgical department and the adenoma was successfully removed. Approximately one year after his initial hospitalization, his cardiac structure and function had nearly returned to normal and there were no high BP and signs of Cushing's syndrome.