title: Chronic central serous chorioretinopathy as a presenting symptom of Cushing syndrome.
abstract: OBJECTIVE
  To describe 4 patients who were diagnosed with chronic central serous chorioretinopathy (cCSC), which appeared to be the presenting symptom of Cushing syndrome (CS).
  
  
  METHODS
  In this retrospective review of charts, all patients received extensive ophthalmologic examination and endocrinologic analyses.
  
  
  RESULTS
  A 56-year-old man and a 49-year-old woman were treated because of bilaterally active, therapy-resistant cCSC. The clinical sign indicative for CS leading to referral to the endocrinologist was muscle weakness in the man and plethora in the woman. In a 37-year-old woman with known diabetes mellitus and central obesity, bilateral cCSC was diagnosed before CS screening. Another 49-year-old woman was treated for unilateral cCSC for 4 years. Complaints of fatigue, muscle weakness, central adiposity, and skin atrophy led to referral and a CS diagnosis due to bilateral macronodular adrenal hyperplasia. In all patients, CS surgery resulted in complete resolution of subretinal fluid. During postsurgical follow-up, no reactivation of cCSC was observed.
  
  
  CONCLUSIONS
  Chronic CSC can be the principal manifestation of relatively mildly symptomatic and unrecognized CS. In patients with cCSC, ophthalmologists should have a high index of suspicion for clinical signs of CS that warrant endocrinologic analysis. Cushing syndrome surgery can stop active subretinal fluid leakage in cCSC.
authors.affiliation: Department of Ophthalmology, Leiden University Medical Center, Leiden - The Netherlands.
authors.forename: Elon H C
authors.initials: EH
authors.lastname: van Dijk
authors.affiliation: Department of Ophthalmology, Leiden University Medical Center, Leiden - The Netherlands.
authors.forename: Greet
authors.initials: G
authors.lastname: Dijkman
authors.affiliation: Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, Leiden University Medical Center, Leiden - The Netherlands.
authors.forename: Nienke R
authors.initials: NR
authors.lastname: Biermasz
authors.affiliation: Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, Leiden University Medical Center, Leiden - The Netherlands.
authors.forename: Femke M
authors.initials: FM
authors.lastname: van Haalen
authors.affiliation: Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, Leiden University Medical Center, Leiden - The Netherlands.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
authors.affiliation: Department of Ophthalmology, Leiden University Medical Center, Leiden - The Netherlands.
authors.forename: Camiel J F
authors.initials: CJ
authors.lastname: Boon
mesh_terms: D000328:Adult; D056833:Central Serous Chorioretinopathy / Q000175:diagnosis* / Q000188:drug therapy; D002908:Chronic Disease; D004396:Coloring Agents / Q000008:administration & dosage; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D012189:Retrospective Studies; D058471:Subretinal Fluid; D014792:Visual Acuity
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green