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Klin Monbl Augenheilkd 2003; 220(3): 199-203
DOI: 10.1055/s-2003-38187
Kasuistik
© Georg Thieme Verlag Stuttgart · New York

Central Serous Chorioretinopathy Associated with Adrenal Myelolipoma

Zentrale seröse Chorioretinopathie bei Patienten mit adrenalem MyelolipomJohn  M.  Katsimpris1 , Makis  Vandoros2 , Ioannis  K.  Petropoulos3 , Panagiotis  Andrikopoulos4
  • 1Department of Ophthalmology, General Hospital of Patras „Agios Andreas”, Patras, Greece (Dir.: D. Feretis, MD, PhD)
  • 2Laboratory of Pathology, General Hospital of Aegion, Aegion, Greece (Dir.: A. Kominea, MD, PhD)
  • 3Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland (Dir.: Prof. A. B. Safran, MD, PhD)
  • 4Department of Surgery, General Hospital of Aegion, Aegion, Greece (Dir.: P. Andrikopoulos, MD, PhD)
Poster presentation at the 95th Congress of the SSO (Luzern, 25. - 28.9.2002)
Further Information

Publication History

Eingegangen: 30. September 2002

Angenommen: 29. November 2002

Publication Date:
28 March 2003 (online)

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Zusammenfassung

Hintergrund: Wir beschreiben einen Patienten mit zentraler seröser Chorioretinopathie und mit einem großen adrenalen Myelolipom. Anamnese und Befund: Ein 55-jähriger Mann wurde uns wegen eines Sehschärfeverlustes des rechten Auges überwiesen. Aufgrund der Augenuntersuchung und einer Angiographie wurde eine zentrale seröse Chorioretinopathie diagnostiziert. Wegen eines systemischen Bluthochdruckes wurde eine klinische und labortechnische systemische Gesamtuntersuchung eingeleitet. Therapie und Verlauf: Die klinischen und labortechnischen Untersuchungen haben eine große Raumforderung im rechten Oberbauch zutage geführt. Mithilfe der Magnetresonanz konnte diese Masse als Tumor der rechten Nebennierendrüse diagnostiziert werden. Einen Monat später wurde der Tumor entfernt und der histologische Befund eines Myelolipoms gestellt. Die zentrale seröse Chorioretinopathie ging zwei Monate später zurück und der systemische Bluthochdruck verschwand. Die Steroidsekretion im Urin, welche vor der Operation erhöht war, ging auf normale Werte zurück. Schlussfolgerungen: Obwohl die genauen pathogenen Mechanismen der zentralen serösen Chorioretinopathie nicht bekannt sind, wurden sowohl Änderungen im Hormonhaushalt und Durchblutungsstörungen, als auch erhöhte Blutkortisonwerte als für das Krankheitsbild verantwortlich angesehen.

Abstract

Background: We describe a case of central serous chorioretinopathy associated with a large adrenal myelolipoma. History and signs: A 55-year old man was admitted to our clinic complaining for metamorphopsia and blurred vision in his left eye. Standard ophthalmologic examination and fluorescein angiography established the diagnosis of central serous chorioretinopathy (CSC). Due to the presence of arterial hypertension, we proceeded to a thorough systemic clinical and laboratory investigation. Therapy and outcome: Clinical and laboratory investigation disclosed a large mass in the right abdominal region. Magnetic resonance imaging showed that this mass was located superior to the right kidney, in the right adrenal gland, compressing the kidney and the liver. Surgical excision of the mass was done one month later. Histological examination revealed an adrenal myelolipoma. Improvement of CSC was recorded one month after surgery with complete remission two months later. Additionally, systemic blood pressure and increased urinary steroids concentration before the operation returned to normal in the late postoperative period. Conclusions: CSC pathogenesis is not well understood. Many factors are implicated in this disease. Hypercortisolism and sympathetic activity play a crucial role in the pathogenesis of CSC. This is the first report of CSC in a patient with a benign tumor of the adrenal gland without Cushing's syndrome.

Schlüsselwörter

Zentrale seröse Chorioretinopathie - adrenale Myelolipom - systemischer Bluthochdruck - Blutkortisonwerte - Epinephrin

Key words

Central serous chorioretinopathy - adrenal myelolipoma - systemic hypertension - hypercortisolism - epinephrine

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Dr. John M. Katsimpris

Department of Ophthalmology · General Hospital of Patras „Agios Andreas”

215 Patron-Klaous str.

26335 Patras · Greece

Email: jkatsimpris@yahoo.com or johnkatsjohnkats@netscape.net