Choroidal and Retinal Abnormalities in Cushing Syndrome: Correlation with Cortisol Level

Abstract

Purpose: To investigate the structure and blood flow of the retina and choroid in Cushing syndrome (CS) and their relationship with cortisol levels. Methods: A consecutive series of CS patients with adrenocortical carcinoma were included in this study. Cortisol levels gradually returned to normal after adrenalectomy. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) were used to assess CS patients before and after the surgery for retina and choroid. Correlation analysis was performed between cortisol level and fundus changes. Results: Compared with normal cortisol levels, CS patients had significantly lower central macular thickness (CMT) with increased cortisol level (220.82 ± 16.59 μm and 223.68 ± 15.78 μm, p = 0.019). While the central choroidal thickness (CCT) was higher with increased cortisol level (255.18 ± 105.89 μm and 205.94 ± 87.04 μm, p < 0.001). The choriocapillaris flow area (CCFA) was higher with increased cortisol level (2.05 ± 0.14 mm2 and 2.00 ± 0.13 mm2, p = 0.02). The change of CCFA was correlated with the score of Huaxi Emotional-distress Index and 24-hour urine-free cortisol (24h-UFC). Conclusion: The increased cortisol level was correlated with lesser CMT and thicker CCT. The decrease of CCFA was correlated with 24h-UFC, indicating the effect of increased cortisol level on choroidal vessels.