Persistența riscului crescut de accident vascular cerebral după tratamentul bolii Cushing – prezentare de caz

Abstract

Introduction: Actual data about persistence of increased risk of cardiovascular events because of previously hypercorticism in patients with Cushing’s disease correctly treated are contradictory. We present the case of a female patient with treated Cushing’s disease that progress to a stroke. Clinical case: A 46-year-old female patient was admitted to neurology department with GSC 8 coma. She had been found to have Cushing’s disease 8 years ago when she underwent bilateral suprarenalectomy followed by external irradiation of the hypophysis; now she follows substitutive treatment. Physical examination revealed a comatose patient with right hemiplegia and superior Foville syndrome, bilateral bronchial rales and subcrepitations, and moderate elevation of arterial blood pressure. Laboratory investigations showed inflammatory syndrome, neutrophil leukocytosis and hypercholesterolemia. Hormone determinations showed euthyroidism, normoprolactinemia and normal gonadotropines levels. Computer tomography of the head demonstrated an area of hypodensity on the left middle and anterior cerebral arteries territories. Diagnosis of Ischemic Stroke, Bronchopneumonia, Chronic Adrenal Insufficiency secondary to bilateral suprarenalectomy and Arterial Hypertension were made. Consequently to hydroelectrolytic reequilibration, treatment with cerebral depletives (mannitol 20%, dexamethasone), mineralocorticoid, fractionated heparin, antihypertensives and third-generation cephalosporin she got better her consciousness remaining only a mid aphasia. Conclusion: This case presentation suggests that the hypercorticism and irradiation of the hypophysar area may be considered risk factors for strokes. Early diagnosis and adequate treatment of Cushing’s disease are important for prevention of cerebrovascular complications.