Hypercoagulability in Cushing Syndrome

Posted on September 7, 2025 by MaryO

Introduction

Cushing syndrome is a prevalent endocrine disorder that impacts multiple bodily systems. Although 80% of patients have ACTH-dependent Cushing syndrome (typically caused by Cushing disease), around 20% of ACTH-independent CS are noted mostly due to adrenal adenoma. Patients with this condition have an approximately 8% risk of thromboembolism. This hypercoagulable state is thought to result from the activation of the coagulation cascade, along with impaired fibrinolysis and prolonged clot lysis time. Vigilance in recognizing and managing these complications is essential to improving patient outcomes.

Section snippets

Case Report

A 44-year-old woman with a medical history of type 2 diabetes mellitus, obesity, and tobacco dependence presented to the clinic for obesity management. She had been started on weight loss medication, but there was minimal improvement in her condition. The patient denied using steroids or oral contraceptive pills and reported well-controlled diabetes. Due to the lack of progress, an extensive workup was conducted, revealing the following: an am cortisol of 2.4 mcg/dL after 1 mg of dexamethasone

Case Report

Few days later, she was admitted to the emergency department with acute hypoxia, requiring up to 6 L of oxygen via nasal cannula, and severe abdominal pain. A CT scan of the chest, abdomen, and pelvis revealed a right renal infarct, a splenic infarct, and a pulmonary embolism. A venous duplex of the left lower extremity was negative for deep vein thrombosis, and hypercoagulable workup was also negative. An echocardiogram identified a patent foramen ovale, which was repaired, and she was started

Discussion

This case highlights the necessity of providers to be aware of potential complications of endocrinological disorders. The risk of thromboembolism is more commonly present in patients with Cushing syndrome, who have risk factors such as obesity, surgery and invasive diagnostic procedures. Patients should be treated as having a prothrombotic disorder and undergo antithrombotic prophylaxis following procedures. The risk of thromboembolism in patients with Cushing syndrome should be widely

Conclusion

This case highlights the necessity of providers to be aware of potential complications of endocrinological disorders. The risk of thromboembolism is more commonly present in patients with Cushing syndrome, who have risk factors such as obesity, surgery and invasive diagnostic procedures. Patients should be treated as having a prothrombotic disorder and undergo antithrombotic prophylaxis following procedures. The risk of thromboembolism in patients with Cushing syndrome should be widely

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Severe Psychosis Due to Cushing Syndrome

Posted on August 28, 2025 by MaryO

Cushing syndrome (CS) is a rare clinical condition resulting in excess cortisol production. Neuropsychiatric disturbances are prevalent, in addition to the well-known metabolic effects. Depression and anxiety are the most common manifestations, while mania and psychosis are rare.1,2 We report the case of a patient who presented with severe psychosis due to adrenocorticotropic hormone (ACTH)–dependent CS due to a pituitary adenoma (PA).

Case Report

A 47-year-old woman was brought to the hospital after she was found wandering on someone’s property 2 days after her parents had filed a missing person report. She was disoriented, had difficulty recalling events, and reported intrusive thoughts. She had a history of hypertension, hyperlipidemia, prediabetes, and schizoaffective disorder diagnosed 10 years ago when she had an episode of acute psychosis. She was noncompliant with her medications.

On presentation, her blood pressure was 160/111 mm Hg, pulse rate was 111 bpm, and body mass index was 24.14 kg/m2. The psychiatric examination revealed disorientation, thought disorganization, subdued mood, blunted affect, and impaired memory and attention. She had central adiposity and coarse terminal hair growth on her chin; the rest of the physical examination was unremarkable. She was started on olanzapine but developed catatonia after 10 days. Olanzapine was discontinued after 4 weeks as her catatonia worsened. Due to the worsening of hypertension, her random cortisol level was checked and found to be elevated at 51.8 μg/dL (2.9–19.4 μg/dL). Further workup was deferred due to testing difficulty in the setting of acute psychosis. A trial of aripiprazole was initiated but was discontinued after 10 days due to the persistence of catatonia. She then received electroconvulsive therapy on alternate days for 11 sessions, with improvement in her symptoms.

The workup of CS was initiated due to the difficulty in managing her symptoms, weight gain, worsening of hypertension, and pedal edema. Laboratory investigations showed potassium of 2.7 mEq/dL (3.5–5.5 mEq/dL), elevated serum cortisol of 39.3 μg/dL (2.9–19.4 μg/dL), and ACTH of 100.2 pg/dL (7.2–63.3 pg/dL). Her 24-hour urinary free cortisol level was 2,340 and 1,180 (≤45 μg/dL) on 2 separate occasions, thyroid-stimulating hormone was 0.02 (0.4–4.0 mIU/L), and free thyroxine was 0.6 (0.7–1.9 ng/dL). The dexamethasone suppression test was also abnormal. Given that her ACTH level was elevated, there was a high concern for a PA. A magnetic resonance imaging scan revealed a 9.3 x9.6–mm nonenhancing focus on the posterior aspect of the pituitary, which confirmed the diagnosis of ACTH-dependent CS. Central hypothyroidism was attributed to the mass effect of the PA. Transsphenoidal PA resection was performed with subsequent improvement in her symptoms.

Discussion

Acute psychosis may be the initial manifestation of CS. This can easily be overlooked, especially in patients with preexisting psychiatric conditions. CS can be indolent, with clinical and neuropsychiatric features often beginning years before diagnosis. In this case, the initial presentation a decade ago could also be attributed to CS. Many antipsychotic drugs can result in metabolic syndrome, which can be hard to differentiate from manifestations of CS.3 Individuals with neuropsychiatric disorders can have elevation in their cortisol levels due to activation of the hypothalamic-pituitary axis, especially in the evening, without the presence of any pituitary or adrenal adenomas (these result in pathological hypercortisolism).4 This is known as pseudo-CS or physiological hypercortisolism.5 Based on clinical features alone, physiological and pathological hypercortisolism can be hard to distinguish. A high index of clinical suspicion is needed, with repeat testing often required, as there are no specific cutoffs to distinguish between these conditions.6,7

In patients with severe neuropsychiatric illness and features of metabolic syndrome, a diagnosis of CS should be strongly considered, especially in those not responding to conventional treatment strategies. Early recognition and treatment can lead to improved outcomes, though complete recovery of psychiatric symptoms may not be seen in some patients.8,9

AnchorArticle Information

Published Online: August 21, 2025. https://doi.org/10.4088/PCC.25cr03957
© 2025 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2025;27(4):25cr03957
Submitted: March 6, 2025; accepted April 30, 2025.
To Cite: Dhaliwal G, MD; Kaur JK, Batra J, et al. Severe psychosis due to Cushing syndrome. Prim Care Companion CNS Disord 2025;27(4):25cr03957.
Author Affiliations: Department of Endocrinology, Diabetes and Metabolism, HealthPartners Institute, Minneapolis, Minnesota (Dhaliwal, JK Kaur, J Kaur); Department of Endocrinology, University of Nebraska, Omaha, Nebraska (Batra).
Corresponding Author: Jasleen Kaur, MD, Department of Endocrinology, Diabetes and Metabolism, HealthPartners Institute, 401 Phalen Blvd, St Paul, MN 55130 (jasleen.x.kaur@healthpartners.com).
Relevant Financial Relationships: None.
Funding/Support: None.
Patient Consent: Consent was received from the patient to publish the case report, and information has been de-identified to protect patient anonymity.
ORCID: Jasleen Kaur: https://orcid.org/0000-0002-0584-4638

From https://www.psychiatrist.com/pcc/severe-psychosis-due-cushing-syndrome/

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Graphic Era Hospital’s Milestone Treatment of Two Complex Cases

Posted on August 26, 2025 by MaryO
DEHRADUN, 23 August: Graphic Era Hospital has achieved a remarkable mileston by successfully treating two complex cases of the rare hormonal disorder Cushing’s Disease in Dehradun. The hospital’s experts used advanced technology and surgical skills to give the patients a new lease on life, marking this significant achievement.
In the first case, a 27-year-old woman was brought to the Endocrinology Department at Graphic Era Hospital after long-term weight gain, facial puffiness, irregular menstrual cycles, high blood pressure, and kidney stones. Tests and lab reports confirmed that the patient was suffering from ACTH-dependent Cushing’s Syndrome – Pituitary Microadenoma. A 3-Tesla Dynamic Pituitary MRI revealed a 6 mm tumor, while other organs were normal.
The specialists performed surgery using endoscopic trans-nasal neuro-navigation technology, completing it successfully without opening the brain. After the operation, the patient experienced significant weight loss, normalized blood pressure, regular menstrual cycles, and all hormone levels returned to normal.
In the second case, a 24-year-old woman came to Graphic Era Hospital with extremely high blood pressure (200/100), headache, weight gain, and irregular menstrual cycles. MRI revealed a 7–9 mm tumor in an unusual location in the pituitary gland, which was also affecting the pituitary fossa bone. Despite multiple medications, her blood pressure remained uncontrolled, and CT scans showed an impact on her heart.
The multi-specialty team performed surgery using endoscopic trans-nasal neuro-navigation technology, again without opening the brain. After surgery, her blood pressure normalized and her menstrual cycles became regular.
In both cases, pituitary microadenomas were diagnosed. The surgeries were done through the nasal route using microscopes and endoscopes, with neuro-navigation helping to accurately locate the tumors while protecting the pituitary gland. The multi-specialty team included Head of Neurosciences and HOD Neurosurgery Partha P Bishnu, Senior Consultant Neurosurgery Ankur Kapoor, Senior Neurosurgeon and Neurointervention Specialist Payoz Pandey, Senior Consultant ENT Parvendra Singh, Director Endocrinology, Obesity and Diabetes Sunil Kumar Mishra, and the Neuro-Anesthesia Team.
With the latest technology and expert doctors at Graphic Era Institute of Medical Sciences, new milestones continue to be achieved. Previously, the hospital’s expert doctors had successfully implanted pacemakers in the brain, placed a third pacemaker in complex pediatric cases, replaced two heart valves without open-heart surgery, unblocked the esophagus without surgery, and performed open-heart surgery through a small 2.5-inch facial incision without cutting bones. Director of Graphic Era Hospital, Puneet Tyagi,  Mefical Superintendent, Gurdeep Singh Jheetay, Dean SL Jethani and COO Atul Bahl were present at the press conference.

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Cushing Syndrome Leaves Lasting Health Effects

Posted on August 8, 2025 by MaryO

TOPLINE:

Compared with a matched population-based control group, patients with Cushing syndrome continued to exhibit elevated systolic and diastolic blood pressures along with reduced kidney function at least 14 years after biochemical remission.

METHODOLOGY:

  • Researchers in Germany conducted a retrospective cohort study to assess the long-term trajectory of blood pressure and kidney function in patients who achieved remission of Cushing syndrome.
  • They included 81 patients with Cushing syndrome (median age at baseline, 44 years; 75.3% women) and compared them with 243 matched control individuals from a population-based cohort.
  • Data were collected before treatment at baseline and at median follow-up intervals of 7.1 and 14 years after biochemical remission, with assessments of blood pressure, glomerular filtration rate, the prevalence of chronic kidney disease, and the use of antihypertensives.

TAKEAWAY:

  • Patients with Cushing syndrome had a significant reduction in blood pressure and required fewer antihypertensives at both 7 and 14 years vs baseline.
  • However, when compared with the control group, patients with Cushing syndrome had significantly elevated systolic and diastolic pressures at baseline and 7 and 14 years post-remission (P ≤ .0002 for all).
  • Although the proportion of patients on antihypertensive medications decreased in the Cushing syndrome group after remission was achieved, the prevalence of uncontrolled hypertension remained higher than in the control group at all follow-up points. In fact, reducing the use of these medications was associated with an increased risk for uncontrolled hypertension.
  • Kidney function assessed via glomerular filtration rate remained consistently lower among patients with Cushing syndrome than among control individuals at baseline and 7 and 14 years post-remission (P = .005, P < .0001, and P = .0359, respectively).

IN PRACTICE:

“Our findings provide further evidence that cardiovascular effects of hypercortisolism are not entirely reversible with the normalization of cortisol levels and enhance our understanding of the deteriorative long-term cardiovascular consequences of chronic hypercortisolism,” the authors wrote.

SOURCE:

This study was led by Katrin Ritzel, Ludwig-Maximilians-Universität München (LMU Munich), LMU University Hospital in Munich, Germany. It was published online on July 29, 2025, in Journal of Endocrinological Investigation.

LIMITATIONS:

The retrospective design and single-centre nature of this study could have been considered limitations.

DISCLOSURES:

This study was supported by Else Kröner-Fresenius Stiftung. Some authors reported being supported by Deutsche Forschungsgemeinschaft, the Munich Clinician Scientist Program, the Clinician Scientist Pro­gramme on Rare Important Syndromes in Endocrinology, and other sources. All authors reported having no conflicts of interest.

https://www.medscape.com/viewarticle/cushing-syndrome-leaves-lasting-health-effects-2025a1000kj0

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Cushing’s Syndrome Study for Patients and Caregivers

Posted on July 9, 2025 by MaryO

We have an opportunity for you to take part in a Cushing’s Syndrome Study for patients and caregivers. Our project number for this study is SJO_11379.

Project Details:

  • Web-assisted telephone interview (you must be by a computer with high-speed internet access while on the phone during the time of the interview) – WEBCAM REQUIRED
  • Interview is 60-minutes long, plus optional 30-40 minute homework assignment
  • up to 195 Dollar Reward (120 Dollar Reward for Interview, 75 Dollar Reward for completion of optional homework assignment)

Things to Note:

  • Provide detailed and thoughtful responses. Rushed responses may be rejected by the client.
  • Using AI may be flagged, and your reward forfeited.
  • Using a VPN may cause you to disqualify from the study
  • Study is open to patients and caregivers
  • Please do not share study links
  • Please use a laptop/computer ONLY. No smartphones or tablets – Preliminary questions are mobile friendly!
  • Save this email to reference if you have any questions about the study!
  • If you have any problems, email jennifer.harscheid@rarepatientvoice.com and reference the project number.  

If you are interested in this study, please click the link below to answer a few questions to see if you qualify.

Study link: Start Here

OR if the study hyperlink is not clickable above, please copy/paste this URL below.
https://panel.rarepatientvoice.com/newdesign/site/rarepatientvoice/surveystart.php?surveyID=b9bk3vluq338&panelMemberID=trfnbc7mvduh1gseff1h&invite=email

Thanks as always for your participation! Please be aware that by entering this information you are not guaranteed that you will be selected to participate. As always, we do not share any of your contact information without your permission.

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