Case Report: Cushings SyndromePresenting as Hypertensive Emergency with Acute Pulmonary Odema

A 22 Year old obese woman presented to emergency medicine department in severe respiratory distress. It was sudden in onset, progressive & associated with cough with pinkish frothy sputum. Her vitals on arrival to ER were BP of 190/130 mmHg, HR of 136 bpm, RR of 34 cpm, SpO2 of 72% on room air. On examination, there were diffuse fine end inspiratory crepitations bilaterally with severe respiratory distress. Patient was immediately treated for hypertensive emergency with pulmonary odema with intravenous Furosemide, IV Nitroglycerin, Oxygen therapy with NIV CPAP. Upon further evaluation in the observation unit, it was found that the patient was also having hyperglycemia, hypocalcemia, hypokalemia, metabolic alkalosis, obesity, purple striae over the abdomen, with irregular menstrual cycles. A screening test of overnight dexamethasone suppression test was done and found serum cortisol to be significantly elevated (51.49 μg/dL), confirming the diagnosis of cushings syndrome presenting with hypertensive emergency and acute pulmonary odema.