Bilateral central serous chorioretinopathy secondary to pituitary microadenoma
C. Draw morning plasma cortisol levels
This patient exhibited signs of hypercortisolism, including central obesity (Figure 1). He had systemic hypertension, which occurs in most patients with endogenous hypercortisolism,1,2 and elevated intraocular pressure, which has been reported in endogenous hypercortisolism and can be caused by corticosteroid use.3,4 His hemoglobin A1c level was elevated (6.8%), which is consistent with impaired glucose metabolism in endogenous hypercortisolism.2
Fluorescein angiography showed multiple areas of late pinpoint leakage and guttering, which is patchy, mottled hyperfluorescence caused by gravity-related descending tracts of subretinal fluid (Figure 1). These fluorescein angiography findings are typical of central serous chorioretinopathy (CSC), which is characterized by serous detachment of neurosensory retina/retinal pigment epithelium (Figure 2) and choroidal hyperpermeability. The leakage on fluorescein angiography is most consistent with active CSC, whereas the patches of mottled fluorescence are more typical of chronic CSC.