Bilateral Exophthalmos As Unique Manifestation Of Cushing Syndrome

Since the first description of patients with adrenal hypersecretion in 1932, Harvey Cushing noted that one of the clinical features was exophthalmos. We report the case of a young woman, aged 26, who consulted for bilateral proptosis that had been progressing for 2-3 years, accompanied by burning and painful eyes. In a previous consultation. Graves' orbitopathy was suspected, but no clinical and laboratory confirmation was obtained. At the clinical exam, a mild centripetal distribution of body fat was noted along with two small red striae in the inguinal region, therefore Cushing syndrome was suspected. Hormonal assays confirmed the diagnosis and the sonography showed an adrenal adenoma of the right gland of 3.2/2 cm, which was confirmed by CT. Surgery was performed by laparoscopy and the morphological exam confirmed the diagnosis of adrenal adenoma. After surgery, proptosis remitted from 23 mm to 19 mm at three months and to 17 mm at 6 months, along with the burns and eye pain. This case illustrates the possible involvement of the orbital fat in the process of centripetal fat redistribution caused by the cortisol excess.