Vertebral Artery Dissecting Aneurysm With Cushing's Syndrome -Case Report-

Abstract

A 45-year-old woman presented with subarachnoid hemorrhage of World Federation of Neurosurgical Societies grade IV. Cerebral angiography showed a dissecting aneurysm of the right vertebral artery (VA). Internal trapping of the right VA with coils was performed. The postoperative course was uneventful, but she continued to demonstrate moon facies and experience amenorrhea. Computed tomography demonstrated an adrenal tumor. Laparoscopic adrenalectomy was performed under a diagnosis of Cushing's syndrome caused by an adrenal tumor. Overproduction of cortisol caused by Cushing's syndrome may be related to the development of cerebral aneurysm.

Spontaneous Coronary Artery Dissection in a Patient With Cushing's Disease

“…Cushing's syndrome is not traditionally considered a risk factor for SCAD. However, it is characterized by the overproduction of cortisol and a higher rate of cardiovascular events [ 9 , 12 , 13 ]. It is classically related to hypertension, hyperglycemia, hypercholesterolemia, weight gain, and a prothrombotic state [ 9 , 14 ].…”

“…In the literature, there are case reports of aortic and vertebral arterial dissections associated with hypercortisolism [ 7 , 8 , 10 ] or even SCAD in patients treated with high-dose corticosteroids [ 15 ]. Although the aorta differs structurally from coronary arteries, many of the components of the arterial wall, such as elastic and collagen fibers, are similar [ 13 ], which may predict similar effects of cortisol throughout the vascular territory.…”

Onset of Aortic Dissection Complicated with Cushing's Disease: A Case Report and Review of the Literature

“…Most reported cases of Cushing's syndromes complicated with dissecting aortic aneurysm and aortic dissection were adrenal Cushing's syndromes, not Cushing's disease. We performed a review of the literature and found only a few cases of aortic dissection ( 1 , 3 , 5 , 6 , 8 ) and vertebral or cervical artery dissection ( 2 , 4 , 7 ) published in this context. The comprehensive clinical data of nine cases from the literature are listed in Table 2 .…”

“…For example, high serum cortisol levels may affect the smooth muscle layer in the media of the aorta adjacent to cortisone-induced dissecting aneurysm, bringing about cellular metaplastic transformation of smooth muscle cells to fibroblast-like cells. In addition, high serum cortisol levels affect the vascular connective tissue ( 28 , 29 ) and can increase the fragility of blood vessels, thus exerting negative effects by inhibiting collagen liposynthesis and increasing its catabolism ( 2 ).…”

“…Following the first report by Lawrence et al, several reports have noted that Cushing's syndrome is complicated with dissecting aortic aneurysm or aortic dissection after long-term exposure to high cortisol levels (1). Among such cases, many are diagnosed with Cushing's syndrome simultaneously with the onset of aortic dissection (2)(3)(4). In addition, dissecting aortic aneurysm has been found incidentally when Cushing's syndrome was diagnosed (5)(6)(7), and a case of aortic dissection complicated with Cushing's disease, which resulted in death due to aortic dissection five years after removal of a pituitary adenoma, was also described (8).…”