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Journal Français d'Ophtalmologie
Volume 37, n° 10
page e169 (décembre 2014)
Doi : 10.1016/j.jfo.2014.01.018
Lettres à l'éditeur

Open-angle glaucoma secondary to Cushing syndrome related to an adrenal adenoma: Case report
Glaucome à angle ouvert secondaire à un syndrome de Cushing d’origine surrénalienne : à propos d’un cas
 

C. Virevialle a, E. Brasnu a, , b, c , R. Fior d, C. Baudouin a, b, c, e
a Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France 
b Clinical Investigation Center (CIC) 503, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France 
c Vision Institute, Inserm UMRS 968, université Pierre-et-Marie-Curie Paris 6, UMR S 968, CNRS, UMR 7210, 17, rue Moreau, 75012 Paris, France 
d Department of Internal Medicine and Immunology, Antoine-Béclère Hospital, AP–HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France 
e Department of Ophthalmology, Ambroise-Paré Hospital, AP–HP, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt cedex, France 

Corresponding author.
Case report

We report the case of a 26-year-old woman complaining of recent painless loss of vision. Visual acuity was 20/25 in her left eye and 20/63 in her right eye. Intraocular pressure (IOP) was 60mmHg in both eyes with normal pachymetry and open iridocorneal angles. Cup/disk ratios were 0.4 in the right eye and 0.8 in the left eye, with a large Bjerrum scotoma on the left visual field. As IOP was not controlled under maximal treatment, the patient rapidly underwent a non-penetrating deep sclerectomy on both eyes, following our standard procedure, with no early postoperative complication. A few months later, because of an increase in the left eye IOP, a Nd:Yag goniopuncture was performed. It was followed by an iris incarceration that required Argon laser iridoplasty and topic steroid administration. Although the laser was effective, the IOP remained at 30mmHg. Steroids were removed, and IOP immediately decreased to 13mmHg with no further intervention.

Concurrently, diabetes was diagnosed and standard examination showed gynoid obesity and red purple stretch marks. Because of abdominal pain, an abdominal ultrasound exam was performed, which showed a right adrenal mass. Biology showed high levels of urinary cortisol and an undetectable adrenocorticotropic hormone (ACTH) secretion that were consistent with Cushing syndrome. The patient underwent surgical resection of the adrenal tumor. Anatomopathologic examination confirmed the diagnosis of adrenal cortical adenoma. After surgery, the cortisol level decreased progressively.

Discussion

Few cases of Cushing syndrome-induced glaucoma have been reported [1, 2, 3, 4, 5]. In most cases, IOP was normalized after tumor resection. In the present case, IOP was controlled by surgery that was performed before diagnosis of Cushing syndrome. Nevertheless, in this case, the link between hypercortisolism and glaucoma was supported by the high steroid effect on IOP that was observed in the postoperative period. This case shows that if adrenalectomy needs to be delayed, filtering surgery may effectively control glaucoma, and recalls the importance of looking for an underlying pathology in case of uncontrolled or atypical glaucoma.

Disclosure of interest

The authors declare that they have no conflict of interest concerning this article.

References

Haas J.S., Nootens R.H. Glaucoma secondary to benign adrenal adenoma Am J Ophthalmol 1974 ;  78 : 497-500 [cross-ref]
Robbin D.S., Haas J.S. A 16-year follow-up in a corticosteroid-sensitive patient with glaucoma secondary to a benign adrenal adenoma Am J Ophthalmol 1989 ;  107 : 293-295 [cross-ref]
Jonas J.B., Huschle O., Koniszewski G., Buchfelder M., Fahlbusch R. Intraocular pressure in patients with Cushing's disease Graefes Arch Clin Exp Ophthalmol 1990 ;  228 : 407-409 [cross-ref]
Blumenthal E.Z., Muszkat M., Pe’er J., Ticho U. Corticosteroid-induced glaucoma attributable to an adrenocorticotropin-secreting malignant carcinoid tumor of the thymus Am J Ophthalmol 1999 ;  128 : 100-101 [inter-ref]
Khaw K.W., Jalaludin M.Y., Suhaimi H., Harun F., Subrayan V. Endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone production as a rare cause of ocular hypertension J AAPOS 2010 ;  14 : 536-537



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