Cushing症候群による漿液性網膜剥離の1例

Bilateral serous retinal detachment in a case of Cushing's syndrome

　46歳の男性が両眼霧視で受診した。30歳から高血圧の治療中であり．肥満と満月様顔貌が顕著化してきた。副腎腫瘍によるCushing症候群と最近診断された。尿中のカテコールアミンと血中のACTHは正常値であったが，コルチゾール値が血液と尿で上昇していた。矯正視力は左右とも1.0で，両眼の眼底に漿液性網膜剥離があり，後極部では黄白色滲出斑が多発していた。フルオレセイン螢光造影で早期に過螢光，後期に網膜下の色素貯留があった。初診から5週間後に副腎腺腫摘出が行われ，2週間後にコルチゾール値が正常化し、漿液性網膜剥離は消失した。Cushing症候群で漿液性網膜剥離が発症しうることを示す症例である。

A 46-year-old male presented with bilateral blurring of vision. He had been treated for systemic hyper-tension since the age of 30 years. He showed progressive obesity and moon face. He had been diagnosed recently as Cushing syndrome secondary to pararenal tumor. He showed elevated urine and serum levels of cortisol with normal levels of urine catecholamine and serum ACTH. His corrected visual acuity was 1.0 each. Both eyes showed serous retinal detachment with yellow subretinal patches in the posterior fundus. Fluorescein angiography showed hyperfluorescence in the early phase and subretinal dye pooling in the late phase. He underwent removal of adrenal adenoma 5 weeks after his initial visit. The serum cortisol decreased to normal levels 2 weeks later followed by spontaneous resolution of serous retinal detachment. This case illustrates that serous retinal detach-ment may develop as a complication of Cushing syndrome.