SAT-010 - Cushing Disease in Endemic Alcohol-Related Liver Disease Areas: Differentiating the Two to Streamline Diagnosis and Treatment

A male patient in his thirties presented to a hospital in central New Mexico with severe bilateral lower extremity edema, erythema, and pain, prompting admission for management of congestive heart failure. Over the preceding three years, he experienced a rapid 100-pound weight gain over six months followed by progressive decline in overall health. His condition had previously been attributed to type 2 diabetes mellitus, congestive heart failure, and presumed alcohol-related liver disease, despite patient-reported sobriety. During this admission, further evaluation led to the diagnosis of Cushing Disease. The diagnosis was ultimately prompted by consideration of hypercortisolism by a consulting cardiologist. This case highlights the consequences of delayed diagnosis of Cushing disease, underscores the importance of a thorough physical examination, and illustrates how physician bias may contribute to diagnostic error.

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