RECURRENT CAVERNOUS SINUS THROMBOSIS – AN UNUSUAL COMPLICATION OF CUSHING’S DISEASE

Abstract

INTRODUCTION
Cushing’s disease increases risk of venous thromboembolism. However, its association with cavernous sinus thrombosis (CST) is rarely reported. We report a case of Cushing’s disease complicated with recurrent bilateral CST.

CASE
She first presented at age 14 with pituitary apoplexy. Initial investigations showed non-functioning pituitary adenoma. Transphenoidal surgery was done. Left CST was diagnosed 6 months post-surgery when she had severe headache. This prompted further investigations which revealed Cushing’s disease. She was started on warfarin, but developed right CST within 2 months and was switched to enoxaparin. Her cortisol levels remain elevated on surveillance and one year later, a recurrent pituitary macroadenoma was seen on MRI encroaching the left cavernous sinus with left CST. She subsequently underwent petrosal craniotomy for tumour debulking. Enoxaparin was stopped post-surgery, but 6 months post-surgery her MRI now shows presence of right pituitary macroadenoma with right CST with no normalisation of cortisol.

CONCLUSION
CST is a rare complication of Cushings and may occur due to hypercoagulablity due to hypercortisolism and compression from tumour extension from the pituitary fossa.