INCIDENTAL ERYTHROCYTOSIS AS THE FIRST MANIFESTATION OF CUSHING'S SYNDROME

Abstract

CASE
A 23-year-old Filipino female was consulted due to incidental erythrocytosis. Initial physical and laboratory examinations were unremarkable other than an elevated blood pressure. She was initially started on Telmisartan. In the interim, she noted a progressive increase in her weight and abdominal girth. She also developed hirsutism, buffalo hump, and abdominal purplish striae. Her blood pressure was persistently elevated, hence, her Telmisartan was increased to 80 mg/day, with the addition of Carvedilol 25 mg/day, Lercanidipine 20 mg/day, and Spironolactone 50 mg/day. Endocrine work-up showed dyslipidemia, diabetes, and hypercortisolism consistent with Cushing’s Syndrome. Her upper abdominal CT scan revealed a left adrenal gland nodule. She subsequently underwent an open adrenalectomy with pancreatic tail excision due to mass adherence. She was given a stress dose of hydrocortisone prior to the procedure. The histopathologic report was consistent with adrenocortical adenoma. Postoperatively, her erythrocytosis resolved. Her blood pressure was controlled with carvedilol 50mg/day alone. She was discharged with tapering doses of prednisone and insulin.