SHM Converge Scientific Abstract ePoster Gallery-When Typical Cardiometabolic Disease Masks an Atypical Underlying Disorder

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This case describes a 52-year-old man with hypertension and type 2 diabetes who presented with months of progressive dyspnea, edema, weight loss, and major functional decline. On exam, he had elevated jugular venous pressure, crackles, bilateral pitting edema, proximal muscle weakness, and ecchymoses. Initial testing showed severe heart failure with reduced ejection fraction (EF 40–45%), BNP 5000 pg/mL, elevated troponin, and nephrotic-range proteinuria. Imaging also revealed multiple atraumatic fractures of the ribs, clavicle, and vertebrae, plus a 2.5-cm right adrenal nodule.<br /><br />Because of the combination of cardiometabolic disease, adrenal mass, weakness, and fractures, he underwent endocrine evaluation. A dexamethasone suppression test showed morning cortisol of 23 µg/dL, with undetectable ACTH and normal metanephrines, consistent with ACTH-independent hypercortisolism, likely from an adrenal source.<br /><br />The case highlights that Cushing syndrome can present atypically, often masked by common conditions such as hypertension, diabetes, obesity, edema, or heart failure. Chronic cortisol excess can cause myocardial hypertrophy, fibrosis, diastolic dysfunction, and broader cardiovascular remodeling through RAAS activation and mineralocorticoid receptor signaling. In this patient, new heart failure and fractures were key clues prompting the diagnosis.<br /><br />Management focused on adrenalectomy to remove the cortisol-producing lesion, along with diuresis and guideline-directed medical therapy for heart failure. The presentation emphasizes that unexplained or disproportionate heart failure, especially when accompanied by fractures or an adrenal mass, should prompt evaluation for secondary causes such as hypercortisolism. Long-term cardiovascular follow-up remains important because some cardiac changes may persist even after treatment.

Asset Subtitle

Ambre J. Flowers

Meta Tag

Author List Ambre J. Flowers, Elizabeth Roth, Harika Gorti

Category Clinical Vignettes

Concept ACTH-Independent Hypercortisolism

Concept Cushing Syndrome

Concept Dexamethasone suppression test

Concept Adrenalectomy

Concept Morning cortisol

Distinguished Finalist

Presenter Organization Emory University

Presenting Author Ambre J. Flowers

Track Adult

Keywords

Cushing syndrome

ACTH-independent hypercortisolism

adrenal adenoma

heart failure

hypertension

type 2 diabetes

nephrotic-range proteinuria

atraumatic fractures

dexamethasone suppression test

adrenalectomy

ACTH-Independent Hypercortisolism

Cushing Syndrome

Dexamethasone suppression test

Adrenalectomy

Morning cortisol