EXOPHTHALMOS AND IATROGENIC CUSHINGS-SYNDROME

A 38-year-old physician presented with a 9-month history of progressiv e self-administration of oral prednisone less than or equal to 160 mg per day for Addison's disease. Examination demonstrated typical Cushin goid features and bilateral proptosis with elevated intraocular pressu re. Computed tomography disclosed increased intraorbital adipose tissu e. We hypothesize that the increased intraorbital adipose deposition w as due to the differential binding of glucocorticoids to adipose tissu e receptors and an enhancement of lipoprotein lipase activity. We conc lude that the findings in this case may be related to glucocorticoid-i nduced changes in the ocular and periorbital structures. Cushing's syn drome should be considered in the differential diagnosis of acquired e xophthalmos and elevated intraocular pressure and findings of increase d orbital fat on orbital imaging.