Chronic central serous chorioretinopathy as a presenting symptom of Cushing syndrome

Purpose: 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, therapyresistant 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.