Woman’s Blurry Vision Leads to Rare Cushing’s Syndrome Diagnosis

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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The case of a woman with a rare form of Cushing’s syndrome whose main symptom was blurry vision was described in a recent report.

The report, “Intermittent Blurry Vision: An Unexpected Presentation of Cushing’s Syndrome Due to Primary Bilateral Macronodular Adrenal Hyperplasia (PBMAH),” was published in Cureus.

Cushing’s syndrome is marked by unusually high levels of a hormone called cortisol. Cushing’s disease, a form of Cushing’s syndrome where high cortisol levels are brought on by a tumor in the brain’s pituitary gland, accounts for about 80% of all Cushing’s cases.

In this report, a quartet of scientists from Nazareth Hospital, Philadelphia described the case of a 40-year-old woman who sought medical attention due to intermittent episodes of blurry vision that had been going on for several months.

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The patient had a history of treatment-resistant high blood pressure (hypertension) and type 2 diabetes, and had gained about 30–40 pounds over the past year.

As part of her treatment for uncontrolled hypertension, she underwent a kidney ultrasound in late 2020 where clinicians noticed an unusual mass in her right adrenal gland, just above the kidney. The adrenal glands are mainly responsible for making cortisol.

She went to the emergency room the following month because her eyesight was getting worse. Brain scans were unremarkable, but a CT scan of her abdomen revealed she had masses in both adrenal glands. Tests indicated she also had elevated cortisol levels.

The woman was ultimately diagnosed with Cushing’s syndrome secondary to primary bilateral macronodular adrenal hyperplasia (PBMAH) — a condition in which cortisol-producing masses appear on both adrenal glands.

“Cushing’s syndrome due to bilateral cortisol-secreting nodules is rare, accounting for 2% of [Cushing’s] cases,” the researchers wrote, noting that the woman case was unusual because the condition usually affects people in their 50s or 60s..

Researchers said the patient’s blurry vision was probably due to swelling in the eyes related to uncontrolled blood sugar and blood pressure issues.

“Our patient’s presentation as her primary complaint was recurrent episodes of blurry vision that were suspected to be due to osmotic swelling because of her uncontrolled hyperglycemia. Her case was also unusual as she presented at 40 years old, an average of 10 years earlier than is typically diagnosed for PBMAH,” the researchers wrote.

The patient underwent surgical removal of the adrenal glands and was given corticosteroid supplements to maintain cortisol levels within a normal range — a standard care for PBMAH. She continued to be treated for hypertension and diabetes, though the researchers noted that both conditions required less aggressive treatment after the surgery.