Cushing's Syndrome Related Dilated Cardiomyopathy: Favorable Outcome with Treatment

Presentation Number: SUN-0787
Date of Presentation: June 22nd, 2014

Rany Bassam Al-Agha*1 and Aashna Gill2
1Univ of alberta, Edmonton, AB, Canada, 2University of Alberta, Edmonton, AB

Abstract

Cushing’s Syndrome Related Dilated Cardiomyopathy: Favorable Outcome With Treatment.

Rany Al-agha and Aashna Gill. 

Division of Endocrinology, University of Alberta.

Background- Increased cardiovascular risk related to Cushing’s syndrome is an established entity. Atherosclerotic coronary artery disease and hypertension are the two long term sequele of Cushing’s Syndrome that have been emphasized in previous studies, which tend to persist even after treatment of Cushing’s. Unlike coronary artery disease and hypertension, dilated cardiomyopathy secondary to Cushing’s Syndrome appears to be a rare condition which is reversible with treatment of Cushing’s. 

Case-We report a case of a 29 year old male with a history of new onset diabetes and dilated cardiomyopathy, who presented with acute heart failure and stroke. The ejection fraction was 19%. Endocrinology consultation was sought for management of Diabetes. Hemoglobin A1c was 14.5% (4.3-6.1%). The physical exam revealed findings suspicious for Cushing’s. On evaluation he was found to have an elevated 24 hr urinary cortisol of 702 nmol/24 hrs (normal <230nmol/hr), suppressed ACTH of <5 ng/L (normal 10 to 46 ng/l), and a 4 cm adrenal adenoma on CT abdomen. Pathology confirmed adrenocortical adenoma. Surgical resection was done. At one month follow up, there was complete reversal of dilated cardiomyopathy with near normalization of ejection fraction to 55%. At 5 months follow up hemoglobin A1c was normal at 5.4% (4.3-6.1%).

Conclusion-Based on our case and review of literature for other cases of dilated cardiomyopathy associated with Cushing’s, we conclude that dilated cardiomyopathy has a favorable outcome after treatment of Cushing’s. It appears that some patients are diagnosed with dilated cardiomyopathy before the diagnosis of Cushing’s is made. This may be due to high prevalence of obesity and metabolic syndrome in the population, masking the diagnosis of Cushing’s early on. We conclude that patients with no other known cause of dilated cardiomyopathy should be carefully evaluated for Cushing’s Syndrome, as the diagnosis and treatment of Cushing’s alters the management plan and results in complete reversal of this condition.

 

Nothing to Disclose: RBA, AG