Endogenous Cushing's Syndrome Due to Right Adrenal Adenoma Presenting With Bilateral Leg Oedema and Skin Ulceration

Cushing's syndrome (CS) is a rare disorder characterized by an excess of glucocorticoids, leading to distinctive clinical manifestations. However, its presentation can be atypical, complicating diagnosis. We describe a 53-year-old woman's case of endogenous, adrenocorticotropic hormone (ACTH)-independent CS, presenting with bilateral leg edema and shin ulceration, without the classic signs of moon face or truncal obesity initially. Despite being treated for hypertension and dyslipidemia for a decade, and having a history of left capsular hemorrhage, the diagnosis of CS was not considered until extensive testing was conducted. Investigations revealed a low ACTH level, elevated urinary free cortisol, and a right adrenal mass, leading to the diagnosis of CS caused by an adrenal adenoma. Following laparoscopic adrenalectomy, the patient's symptoms rapidly improved. This case underscores the importance of considering CS in the differential diagnosis of edema and skin ulceration, especially when clinical presentations deviate from the norm. It highlights the complexity of CS pathogenesis and the need for thorough evaluation to prevent misdiagnosis, emphasizing that not all patients will present with or recognize the classic.