Cushing's syndrome—transitory immune deficiency state?

Würzburger, M. I.; Prelević, Gordana M.; Brkić, Srdjan; Vučković, Slavica; Pendić, B.

doi:10.1136/pgmj.62.729.657

Cited by 20 publications

(16 citation statements)

References 11 publications

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“…Therefore, we performed total lymphocyte counts also and all the PDH suffering dogs had significant reductions in total lymphocyte counts and specific lymphocyte subsets as compared to healthy control dogs. Several case reports have noted transitory immune deficiencies in patients with HAC (Britton et al 1975;Würzburger et al 1986). One likely explanation for alterations in lymphocyte subsets seen with PDH dogs may reside, at least in part, in overactivity of the HPA axis.…”

Section: Discussionmentioning

confidence: 95%

“…PDH is a model of clinically increased HPA axis activity and results in increased production of glucocorticoids which are capable of suppressing the immune system. Several case reports have noted transitory immune deficiencies in patients with HAC (Britton et al 1975;Würzburger et al 1986). In addition, rodent studies have confirmed these findings, and rodents are very sensitive to hematological and immunological effects of steroids (Claman 1972).…”

Section: Introductionmentioning

confidence: 95%

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Assessing the immune state of dogs suffering from pituitary gland dependent hyperadrenocorticism by determining changes in peripheral lymphocyte subsets

et al. 2009

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In order to evaluate the immune state of dogs suffering from pituitary-dependent hyperadrenocorticism (PDH), peripheral lymphocyte subsets were examined. Twenty seven PDH dogs and eight healthy control dogs were used in the current study. Eight healthy dogs served as the control group. Twenty seven PDH dogs were categorized into 4 groups based on their post serum cortisol concentrations by ACTH stimulation test: 2-5, excellent control (n = 8); 5-20, fair control (n = 7); >20, poor control (n = 4); and untreated (n = 8). Cell counts were executed with white blood cells (WBC), lymphocytes, CD3(+) (T lymphocytes), CD4(+) (Helper T lymphocytes), CD8(+) (Cytotoxic T lymphocytes), CD21(+) (B lymphocytes) cells in addition to calculating CD4(+)/CD8(+) ratio. Results indicated a significant difference in lymphocyte numbers and lymphocyte subset populations (CD3(+), CD4(+), CD8(+), and CD21(+) cells) between PDH and control dogs. Moreover, comparison of the PDH groups (excellent control; fair control; poor control; untreated) demonstrated that all groups had a significant decrease in lymphocytes numbers (CD3(+), CD4(+) and CD21(+) cell counts) as compared to control group. Meanwhile, no significant differences were observed in WBC counts and CD4(+)/CD8(+) ratio between groups. Furthermore, lymphocyte subset distribution in excellent control PDH dogs without concurrent disease (n = 4) better resembled that of control dogs as compared to PDH dogs with concurrent disease (n = 4). PDH dogs may be suffering from an immuno-depressed state as evidenced by significant differences in lymphocyte subset populations. Furthermore, treatment of both PDH and concurrent disease might improve lymphocyte subset distribution.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 95%

Assessing the immune state of dogs suffering from pituitary gland dependent hyperadrenocorticism by determining changes in peripheral lymphocyte subsets

et al. 2009

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“…In terms of infection risk, glucocorticoids suppress the inflammatory response and are immunosuppressive, and Cushing's syndrome has been suggested to be a transitory immune deficiency state (215). Indeed, there are many case reports and studies reporting opportunistic infection in Cushing's syndrome with infections such as pneumocystis (216,217), aspergillus (218), other invasive fungal infections (219), mycobacterium (220), cytomegalovirus (221), cryptococcal (222), and nocardial infections (223).…”

Section: Infection Riskmentioning

confidence: 97%

Mortality in Patients with Pituitary Disease

et al. 2010

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Pituitary disease is associated with increased mortality predominantly due to vascular disease. Control of cortisol secretion and GH hypersecretion (and cardiovascular risk factor reduction) is key in the reduction of mortality in patients with Cushing's disease and acromegaly, retrospectively. For patients with acromegaly, the role of IGF-I is less clear-cut. Confounding pituitary hormone deficiencies such as gonadotropins and particularly ACTH deficiency (with higher doses of hydrocortisone replacement) may have a detrimental effect on outcome in patients with pituitary disease. Pituitary radiotherapy is a further factor that has been associated with increased mortality (particularly cerebrovascular). Although standardized mortality ratios in pituitary disease are falling due to improved treatment, mortality for many conditions are still elevated above that of the general population, and therefore further measures are needed. Craniopharyngioma patients have a particularly increased risk of mortality as a result of the tumor itself and treatment to control tumor growth; this is a key area for future research in order to optimize the outcome for these patients.

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“…13 In addition to the quantitative decrease in lymphocytes, qualitative abnormalities in lymphocyte function have been reported. 14 The effect of glucocorticoids on subtypes of T lymphocytes has not been well established,15 however, and the selective decrease in CD4 + lymphocytes, which we found in this patient, has not been reported.…”

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confidence: 48%