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Arterial thrombosis as primary presentation of endogenous Cushing’s syndrome
  1. Vijay Alexander1,
  2. Maria Koshy1,
  3. Riddhi Dasgupta2 and
  4. Ronald Albert Carey1
  1. 1 Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
  2. 2 Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
  1. Correspondence to Dr Vijay Alexander, getvijay1990{at}


Cushing’s syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing’s syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing’s syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing’s syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing’s. A diagnosis of endogenous Cushing’s syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.

  • pituitary disorders
  • medical management
  • venous thromboembolism
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  • Patient consent for publication Obtained.

  • Contributors Conception or design of the work and drafting the article: VA. Critical revision of the article: RD, MK, RAC. Final approval of the version to be published: RD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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