Unprovoked Deep Vein Thrombosis as a Manifestation of Cushing's Disease

Cushing's disease is a rare condition, and patients have a higher risk of thromboembolism, specifically venous events. We present a case of a middle-aged woman who underwent sleeve surgery many years ago and slowly regained weight. She had two episodes of unprovoked deep vein thrombosis (DVT), and no risk factors were identified at the time of these events. She presented 10 years later with easy bruising, myopathy, gradual weight gain, and insomnia, and was found to have ACTH-dependent pituitary Cushing's. She successfully underwent endoscopic resection of her pituitary macroadenoma. She had worsening myalgia and myopathy immediately after surgery and is now recovering from glucocorticoid withdrawal syndrome after having untreated Cushing's disease for many years. Her insomnia has resolved almost completely, she has lost 60 pounds, her hypertension has resolved completely, and now she is off medications and remains in remission after 22 months. We conclude that Cushing's disease should be viewed as a risk factor for unprovoked venous thromboembolism and screened for, especially in obese patients.