title: Biventricular hypertrophy and heart failure as initial presentation of Cushing's disease.
abstract: We present a unique case of a 32-year-old woman with severe biventricular hypertrophy and acute heart failure with reduced left ventricular ejection fraction of 25-30% due to Cushing's disease. The patient was admitted to a specialised cardiac unit and treated with conventional therapy against heart failure. The department of endocrinology was consulted because of clinical suspicion of Cushing's syndrome. Initial biochemistry indicated the presence of adrenocorticotropic hormone (ACTH) dependent Cushing's syndrome and a dexamethasone suppression test confirmed the diagnosis. A cerebral MRI scan revealed a pituitary adenoma and a sinus petrosus inferior catheterisation confirmed increased production of ACTH from the pituitary. The patient was referred to the neurosurgical department and the adenoma was successfully removed by transsphenoidalic catheterisation and ablation. Five months following the initial hospitalisation the patient was nearly in full recovery with respect to her cardiac function and biochemically there were no signs of Cushing's syndrome.
authors.affiliation: Department of Cardiology, University Hospital of Odense, Odense, Denmark.
authors.forename: Thomas Morris
authors.initials: TM
authors.lastname: Hey
authors.forename: Jordi Sanchez
authors.initials: JS
authors.lastname: Dahl
authors.forename: Thomas Heiberg
authors.initials: TH
authors.lastname: Brix
authors.forename: Eva Vad
authors.initials: EV
authors.lastname: Søndergaard
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D006332:Cardiomegaly / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D017380:Hypertrophy, Right Ventricular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D047748:Pituitary ACTH Hypersecretion / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome