Angio-oedema after trans-sphenoidal surgery in a patient with Cushing's disease.

Cushing’s disease is bilateral adrenocortical hyperplasia secondary to excessive secretion of ACTH by the pituitary gland. Angio-oedema is due to oedema in the deeper subcutaneous and submucosal tissues. We report a patient with acquired angio-oedema which developed after transsphenoidal surgery for Cushing’s disease (CD). A 50-year-old woman admitted to the endocrinology department with a two-month history of weakness, weight gain, bruising and hypertension. On examination, she had moon facies, hypertrichosis, truncal obesity and non-pitting oedema. Results of laboratory investigations showed that baseline cortisol 40 g/dl (5—25 g/dl), urine cortisol 450 g/24 hours (80—120 g/24 hours) and ACTH 100 pg/ml (0—46 pg/ml) levels were out of the normal range. Serum cortisol levels failed to suppress after low dose dexamethasone (DST) (1mg>50 g/dl). Abdominal MR revealed a solid mass 1.9×1 cm in size