AIM:To investigate the potential of optical coherence tomography angiography(OCTA)for detecting subclinical microvascular damage,possibly before ocular complications develop,in treatment-naive Cushing’s disease(CD)pa...AIM:To investigate the potential of optical coherence tomography angiography(OCTA)for detecting subclinical microvascular damage,possibly before ocular complications develop,in treatment-naive Cushing’s disease(CD)patients.METHODS:This retrospective cross-sectional study included 48 newly diagnosed,treatment-naive CD patients and 48 healthy controls.Ophthalmological examinations,including best-corrected visual acuity,intraocular pressure,optical coherence tomography(OCT),and OCTA were conducted.Retinal and choroidal vessel density(VD)parameters were assessed in the macular and peripapillary regions.Correlations between VD and systemic hormone levels were analyzed.RESULTS:Age(47.3±13.3y vs 43.4±15.8y;P=0.053)and gender distribution(CD:35 females,13 males;controls:34 females,14 males;P=1.000)did not significantly differ.Patient group exhibited significant reductions in radial peripapillary capillary(RPC;P<0.05)and choriocapillaris(CC)VD across all quadrants(P<0.05)compared to controls.Nasal deep capillary plexus(DCP)VD was also significantly decreased(P=0.035).Subfoveal choroidal thickness(SFCT;P=0.459)did not differ significantly,but nasal choroidal thickness(CT)at 1500μm(P<0.040)and 3000μm(P<0.031)was markedly increased.Notably,hormonal correlations revealed associations between ACTH and temporal CC VD(r=0.367,P=0.009),plasma cortisol and superior RPC VD(r=0.303,P=0.034),and urinary free cortisol with superior,and nasal RPC(r=-0.404,P=0.004,r=-0.317,P=0.027)and nasal DCP VD(r=-0.287,P=0.045).CONCLUSION:High endogenous cortisol levels in CD patients primarily affect the peripapillary region and the nasal part of the macula.VD changes occur before pachyvessel formation,choroidal thickening,and the development of pachychoroid spectrum disorder.展开更多
BACKGROUND Ectopic Cushing syndrome(ECS)is a rare condition commonly associated with neuroendocrine tumors(NET),mainly bronchial carcinoids.The association of paraneoplastic syndrome with Merkle cell carcinoma(MCC)is ...BACKGROUND Ectopic Cushing syndrome(ECS)is a rare condition commonly associated with neuroendocrine tumors(NET),mainly bronchial carcinoids.The association of paraneoplastic syndrome with Merkle cell carcinoma(MCC)is limited to individual case reports.CASE SUMMARY In this article we report an unusual and striking presentation of ECS in a patient with known metastatic MCC.An elderly patient presented with new onset severe hypertension,hyperglycemia and hypokalemia,muscle wasting,and peripheral edema.A diagnosis of adrenocorticotropic hormone dependent,non-pituitary,Cushing syndrome was established.Medical therapy inhibiting adrenal function was promptly started but unfortunately the patient survived only a few days after diagnosis.CONCLUSION The occurrence of an aggressive form of ECS in patients with NET should be recognized as an ominous event.To our knowledge,the association of this complication in a patient with MCC had not been reported.展开更多
BACKGROUND Polyostotic fibrous dysplasia(PFD)is an uncommon developmental bone disease in which normal bone and marrow are replaced by pseudotumoral tissue.The etiology of PFD is unclear,but it is generally thought to...BACKGROUND Polyostotic fibrous dysplasia(PFD)is an uncommon developmental bone disease in which normal bone and marrow are replaced by pseudotumoral tissue.The etiology of PFD is unclear,but it is generally thought to be caused by sporadic,post-zygotic mutations in the GNAS gene.Herein,we report the case of a young female with bone pain and lesions consistent with PFD,unique physical findings,and gene mutations.CASE SUMMARY A 27-year-old female presented with unbearable bone pain in her left foot for 4 years.Multiple bone lesions were detected by radiographic examinations,and a diagnosis of PFD was made after a biopsy of her left calcaneus with symptoms including pre-axial polydactyly on her left hand and severe ophthalmological problems such as high myopia,vitreous opacity,and choroidal atrophy.Her serum cortisol level was high,consistent with Cushing syndrome.Due to consanguineous marriage of her grandparents,boosted whole exome screening was performed to identify gene mutations.The results revealed mutations in HSPG2 and RIMS1,which may be contributing factors to her unique findings.CONCLUSION The unique findings in this patient with PFD may be related to mutations in the HSPG2 and RIMS1 genes.展开更多
文摘AIM:To investigate the potential of optical coherence tomography angiography(OCTA)for detecting subclinical microvascular damage,possibly before ocular complications develop,in treatment-naive Cushing’s disease(CD)patients.METHODS:This retrospective cross-sectional study included 48 newly diagnosed,treatment-naive CD patients and 48 healthy controls.Ophthalmological examinations,including best-corrected visual acuity,intraocular pressure,optical coherence tomography(OCT),and OCTA were conducted.Retinal and choroidal vessel density(VD)parameters were assessed in the macular and peripapillary regions.Correlations between VD and systemic hormone levels were analyzed.RESULTS:Age(47.3±13.3y vs 43.4±15.8y;P=0.053)and gender distribution(CD:35 females,13 males;controls:34 females,14 males;P=1.000)did not significantly differ.Patient group exhibited significant reductions in radial peripapillary capillary(RPC;P<0.05)and choriocapillaris(CC)VD across all quadrants(P<0.05)compared to controls.Nasal deep capillary plexus(DCP)VD was also significantly decreased(P=0.035).Subfoveal choroidal thickness(SFCT;P=0.459)did not differ significantly,but nasal choroidal thickness(CT)at 1500μm(P<0.040)and 3000μm(P<0.031)was markedly increased.Notably,hormonal correlations revealed associations between ACTH and temporal CC VD(r=0.367,P=0.009),plasma cortisol and superior RPC VD(r=0.303,P=0.034),and urinary free cortisol with superior,and nasal RPC(r=-0.404,P=0.004,r=-0.317,P=0.027)and nasal DCP VD(r=-0.287,P=0.045).CONCLUSION:High endogenous cortisol levels in CD patients primarily affect the peripapillary region and the nasal part of the macula.VD changes occur before pachyvessel formation,choroidal thickening,and the development of pachychoroid spectrum disorder.
文摘BACKGROUND Ectopic Cushing syndrome(ECS)is a rare condition commonly associated with neuroendocrine tumors(NET),mainly bronchial carcinoids.The association of paraneoplastic syndrome with Merkle cell carcinoma(MCC)is limited to individual case reports.CASE SUMMARY In this article we report an unusual and striking presentation of ECS in a patient with known metastatic MCC.An elderly patient presented with new onset severe hypertension,hyperglycemia and hypokalemia,muscle wasting,and peripheral edema.A diagnosis of adrenocorticotropic hormone dependent,non-pituitary,Cushing syndrome was established.Medical therapy inhibiting adrenal function was promptly started but unfortunately the patient survived only a few days after diagnosis.CONCLUSION The occurrence of an aggressive form of ECS in patients with NET should be recognized as an ominous event.To our knowledge,the association of this complication in a patient with MCC had not been reported.
基金Supported by National Natural Science Foundation of China,No.81703017The Science and Technology Projects of Guangzhou,China,No.201804010080.
文摘BACKGROUND Polyostotic fibrous dysplasia(PFD)is an uncommon developmental bone disease in which normal bone and marrow are replaced by pseudotumoral tissue.The etiology of PFD is unclear,but it is generally thought to be caused by sporadic,post-zygotic mutations in the GNAS gene.Herein,we report the case of a young female with bone pain and lesions consistent with PFD,unique physical findings,and gene mutations.CASE SUMMARY A 27-year-old female presented with unbearable bone pain in her left foot for 4 years.Multiple bone lesions were detected by radiographic examinations,and a diagnosis of PFD was made after a biopsy of her left calcaneus with symptoms including pre-axial polydactyly on her left hand and severe ophthalmological problems such as high myopia,vitreous opacity,and choroidal atrophy.Her serum cortisol level was high,consistent with Cushing syndrome.Due to consanguineous marriage of her grandparents,boosted whole exome screening was performed to identify gene mutations.The results revealed mutations in HSPG2 and RIMS1,which may be contributing factors to her unique findings.CONCLUSION The unique findings in this patient with PFD may be related to mutations in the HSPG2 and RIMS1 genes.
