Change in postoperative cardiac structure and functions in young women with Cushing’s syndrome

Abstract

Although Cushing’s syndrome causes left ventricular hypertrophy and increases cardiovascular risk, its mechanism remains mostly unclear. We report a case of a patient with Cushing’s syndrome caused by an adrenal adenoma, whose preoperative and postoperative cardiac morphology and function were observed over time using transthoracic echocardiography. The patient was a 30-year-old woman referred to us for refractory hypertension. Echocardiography revealed a left ventricular wall thickness of 14 mm and a relative wall thickness of 0.76, indicating significant concentric hypertrophy. We suspected secondary hypertension and performed various hormone tests. Blood adrenocorticotropic hormone (ACTH) was suppressed and blood cortisol was within the normal range. Detailed examinations revealed high nighttime cortisol levels, no response to ACTH in the adrenocorticotropic hormone-releasing hormone challenge test, and no inhibition of blood cortisol in the 1-mg dexamethasone suppression test, and autonomous cortisol secretion was observed. Cushing’s sign of moon face, hypertension, abnormal menstruation, and glucose intolerance were observed. Based on the above, Cushing’s syndrome was diagnosed. Abdominal computed tomography showed a tumor suspected to be a left adrenal adenoma. Adsterol scintigraphy was performed, which confirmed localization of the left adrenal gland tumor, so laparoscopic left adrenalectomy was performed. In the early postoperative period, there was little improvement in cardiac morphology and hypertension persisted. The findings of cardiac hypertrophy gradually improved, and her condition had mostly normalized 2 years after the operation.