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Cushing’s syndrome diagnosed incidentally on CT imaging
  1. Timber Gillis,
  2. Gavin Low and
  3. Mitchell P Wilson
  1. Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Mitchell P Wilson; mitch.wilson{at}ualberta.ca

Abstract

In this case report, we describe an uncommon presentation of Cushing’s syndrome in a patient in their 60s who presented to the emergency department with left-sided chest pain. The initial workup for the patient was unremarkable except for an elevated blood pressure and elevated fasting plasma glucose. A CT scan of the chest, abdomen and pelvis was performed, demonstrating a splenic artery thrombus with multiple splenic infarcts, in addition to a combination of macronodular adrenal hyperplasia, bilateral gynecomastia, centripetal fat distribution and suspected mild bone demineralisation. Adrenocorticotropic hormone-independent macronodular adrenal hyperplasia, a rare aetiology responsible for Cushing’s syndrome, was raised as a potential unifying diagnosis for the patient’s hypercoagulable status, which was subsequently confirmed on an endocrinological investigation. The case report underscores the importance of communicating clinically relevant details to the imaging specialist in combination with considering a broad differential, including endocrine disorders, when evaluating an undifferentiated patient with atypical imaging findings.

  • Adrenal disorders
  • Radiology

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Footnotes

  • Contributors All authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content. MW gave final approval of the manuscript.

  • 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.