EXOPHTHALMOS IN CUSHINGS-SYNDROME

OBJECTIVE Exophthalmos was noted in 4 of the 12 patients reported by H arvey Cushing in 1932. Although exophthalmos has often been included i n clinical descriptions, no previous study has reported actual measure ments in patients with active and treated Cushing's syndrome, and in c ontrol patients. The aim of this study was to obtain these measurement s. PATIENTS Thirty-one patients with active Cushing's syndrome (19 iat rogenic), 15 with treated Cushing's syndrome, 18 with Graves' ophthalm opathy, 59 control patients, and 3 patients with active Cushing's synd rome plus a family or personal history of thyroid disease. DESIGN AND MEASUREMENTS A consecutive series of patients with active and treated Cushing's syndrome were assessed. They were compared with patients wit h Graves' ophthalmopathy, and with control patients. Exophthalmos was assessed by the author using a Hertel meter. Urinary free cortisol was measured on patients with Cushing's syndrome, and serum thyroxine was estimated for them, and for the patients with Graves' ophthalmopathy. RESULTS Exophthalmos exceeding 16 mm (> 2 SD above normal mean) was f ound in 45% of active Cushing's syndrome, 21% of iatrogenic Cushing's syndrome, 20% of treated Cushing's syndrome, 2% of normal controls, an d 77% of patients with Graves' ophthalmopathy. No patient with Cushing 's syndrome had significant symptoms due to exophthalmos. CONCLUSION P atients with active Cushing's syndrome have statistically significant exophthalmos. This rarely causes symptoms, and diminishes when cortiso l concentrations become normal. Cushing's syndrome and autoimmune thyr oid disease may coexist in patients with exophthalmos.