原因不明の両眼球結膜浮腫をきっかけにクッシング症候群と診断された1例

A case of Cushing's syndrome diagnosed by bilateral conjunctival edema of unknown origin

要約　目的：遷延する原因不明の両眼球結膜浮腫および両眼球結膜充血からクッシング症候群と診断し，原疾患の治療により眼症状の改善が得られた1例について報告する。

症例：53歳，女性。

病歴：6か月前から持続する両眼球結膜浮腫，両眼球結膜充血を主訴に藤沢市民病院眼科を受診した。0.1％ベタメタゾン点眼を使用したが症状は改善しなかった。眼症状の発症と同時期から高血圧，顔面浮腫や両下腿浮腫もみられ胸腹部CT検査を施行したところ，左副腎腫瘍がみられた。血液検査で副腎皮質刺激ホルモンが低値，尿中コルチゾルが高値であり副腎性クッシング症候群と診断され，左副腎摘出術が施行された。手術後速やかな結膜浮腫，結膜充血の改善が得られた。

結論：眼症状を契機に最終的にクッシング症候群の診断に至った症例を経験した。局所の治療に反応せず遷延する両眼の眼球結膜浮腫，眼球結膜充血がみられた場合，全身疾患の1症状として眼症状が起きている可能性があるため他科と連携して精査を進めることが肝要であると考えられた。

Abstract　Objective：To report a case in which Cushing's syndrome was diagnosed from prolonged unexplained bilateral conjunctival conjunctival edema and conjunctival conjunctival hyperemia, and treatment of the primary disease improved ocular symptoms.

Case：53 years old female

History：She visited our department with a chief complaint of bilateral conjunctival conjunctival edema and bilateral conjunctival conjunctival that had persisted for 6 months. Symptoms did not improve after using 0.1％ betamethasone. Hypertension, facial edema and bilateral lower leg edema were also observed at the same time as the ocular symptoms, and chest and abdominal CT examination revealed a left adrenal tumor. Blood tests revealed low ACTH and high urinary cortisol. The patient was diagnosed with adrenal Cushing's syndrome, and left adrenalectomy was performed. Immediately after the operation, conjunctival edema and conjunctival hyperemia were improved.

Conclusion：We experienced a case that finally led to the diagnosis of Cushing's syndrome due to eye symptoms. If there is prolonged binocular conjunctival edema or conjunctival congestion in both eyes that does not respond to local treatment, close examination may be required in cooperation with other departments because ocular symptoms may have occurred as a symptom of systemic disease. It was considered important to proceed.