Unmasking of Sarcoidosis After Successful Management of Cushing's Syndrome

Abstract

Cushing's syndrome is characterized by excessive glucocorticoid secretion leading to immunosuppression. The unmasking or aggravation of autoimmune diseases upon the normalization of cortisol levels after Cushing’s syndrome cure has been reported infrequently.The case of a 45-year-old woman who presented with an 11-month history of severe signs and symptoms of hypercortisolism is reported. Hormonal tests suggested the presence of adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome. Imaging studies detected an adrenal adenoma. The patient underwent laparoscopic adrenalectomy, and the mass was resected. Five months later the patient developed generalized arthralgias, malaise, a dry cough, and erythema nodosum. A diagnosis of sarcoidosis was confirmed by imaging and biopsy.

A case of subcutaneous sarcoidosis in a patient with Cushing's syndrome

“…Subcutaneous sarcoidosis is reported to occur in 1.4%–6% of patients with systemic sarcoidosis. Several cases of sarcoidosis developing after treatment for ' 'Cushing's syndrome have been reported; 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 however, the patient in the current report noticed subcutaneous nodules on her forearm around the same time as when she was diagnosed as having ' 'Cushing's syndrome.…”

“…The authors used the term """Cushing""" and """sarcoidosis""". The clinical features from those case reports 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 and the current case are given in Table 1 . The previous case reports included one male and 9 females with a median age of 37 years (range, 27–45).…”

Testicular swelling leading to a diagnosis of adrenocortical carcinoma – co-incidence or causation?

“…A review of the literature provides food for thought, however, and suggests that ‘Occam’s razor’ should not be immediately dismissed in this case. Noreña-Rengifo et al ( 9 ) report the case of a patient with Cushing’s disease, who, following trans-sphenoidal surgery and cure of hypercortisolism, developed disseminated sarcoidosis. The authors speculate that the drop in serum cortisol levels that occurred following surgery unmasked previously quiescent sarcoidosis, which had been effectively ‘auto-treated’ by the excess cortisol levels present during the period of active Cushing’s disease.…”

Sudden onset of sarcoidosis after successful surgical treatment of Cushing’s syndrome

“…So far, there have been only a few cases of sarcoidosis after surgical treatment of Cushing's syndrome [1,2] or…”