Threetong Thanatporn, Leelawongs Sasikant
Department of Ophthalmology, Faculty of Medicine, Burapha University, Chon Buri, Thailand.
Case Rep Ophthalmol. 2025 May 20;16(1):439-445. doi: 10.1159/000546434. eCollection 2025 Jan-Dec.
Cushing's syndrome results from excessive exposure to exogenous or endogenous steroid, while cushing's disease is hypercortisolism from an adrenocorticotropic hormone-secreting pituitary adenoma. Secondary ocular hypertension (OHT) accompanied by exophthalmos as the initial presentation of endogenous Cushing's syndrome has rarely been reported.
A 46-year-old Thai woman was referred for OHT treatment despite maximum tolerance to medication. Intraocular pressure (IOP) was 21 mm Hg (right eye) and 25 mm Hg (left eye). Visual acuity was 20/20 in both eyes. Bilateral eyelids were swollen without any palpable masses. Exophthalmometer measurements were 24 mm (right eye) and 23 mm (left eye). Extraocular muscle movements, anterior segment, gonioscopy, and dilated fundoscopic exams were normal bilaterally. Optic nerve head was unremarkable in both eyes. Optical coherence tomography showed marginal inferior thinning of the retinal nerve fiber layer and ganglion cell layer in left eye. Computerized visual field 24-2 was normal bilaterally. She was diagnosed with secondary OHT with exophthalmos in both eyes. Thyroid function and thyroid antibody tests were unremarkable. Orbital and brain computed tomography revealed exophthalmos with an increase of retrobulbar fat bilaterally and a hypodense pituitary lesion. She was diagnosed with Cushing's disease and underwent endoscopic transsphenoidal adenectomy. At 6-month postoperatively, IOP decreased to 16 mm Hg (right eye) and 17 mm Hg (left eye), without any IOP-lowering medications. Exophthalmos also improved as exophthalmometer measurements were 20 mm (right eye) and 19 mm (left eye).
Endogenous Cushing's syndrome should be included in the differential diagnosis of secondary OHT with exophthalmos.
库欣综合征是由于长期暴露于外源性或内源性类固醇激素所致，而库欣病是由分泌促肾上腺皮质激素的垂体腺瘤引起的皮质醇增多症。继发性高眼压（OHT）伴有眼球突出作为内源性库欣综合征的首发表现鲜有报道。
一名46岁的泰国女性因尽管对药物治疗已达到最大耐受但仍需治疗高眼压而前来就诊。眼压（IOP）右眼为21毫米汞柱，左眼为25毫米汞柱。双眼视力均为20/20。双侧眼睑肿胀，未触及任何肿块。眼球突出度测量右眼为24毫米，左眼为23毫米。双眼眼外肌运动、眼前节、前房角镜检查和散瞳眼底检查均正常。双眼视神经乳头无异常。光学相干断层扫描显示左眼视网膜神经纤维层和神经节细胞层边缘下方变薄。计算机视野24-2检查双眼正常。她被诊断为双眼继发性高眼压伴眼球突出。甲状腺功能和甲状腺抗体检查无异常。眼眶和脑部计算机断层扫描显示双侧眼球突出伴球后脂肪增多以及垂体低密度病变。她被诊断为库欣病并接受了内镜经蝶窦腺瘤切除术。术后6个月，眼压降至右眼16毫米汞柱，左眼17毫米汞柱，无需任何降眼压药物。眼球突出也有所改善，眼球突出度测量右眼为20毫米，左眼为19毫米。
内源性库欣综合征应纳入伴有眼球突出的继发性高眼压的鉴别诊断。
