Endocrine Abstracts (2010) 22 P195

A rare cutaneous manifestation in Cushing's syndrome: generalized pustular psoriasis

Neslihan Cuhaci1, Dilek Arpaci1, Rifki Ucler1, Ahmet Metin2, Reyhan Ersoy1 & Bekir Cakir1


1Department of Endocrinology and Metabolism, Ankara Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey; 2Department of Dermatology, Ankara, Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey.


Introduction: Generalized pustular psoriasis is a rare and the most severe form of psoriasis. It is usually seen in adults. Generalized pustular psoriasis is characterized with sudden eruption of yellowish pustule groups on the shiny erythematous skin, measuring 2 to 3 mm, and cover the all body in a short time. In this report, we presented a patient with Cushing’s syndrome (CS) who had determined pustular psoriasis.

Case report: A 35 years old woman was admitted because of a widespread erythematous and millimetric brown maculopapular lesions and sterile pustular eruption associated with postinflammatory hyperpigmentation on the head, face, trunk, and extremities. In addition, in her physical examination, she had a facial plethora, hair loss, purple striaes, and hirsutismus. Her biochemical and hormonal tests indicated glucocorticoid excess. Cushing’s syndrome was confirmed by the dynamic tests. Magnetic resonance imaging (MRI) revealed a pituitary lesion of 3.2 mm in diameter. Inferior petrosal sinus sampling (IPSS) was performed. After the results of laboratory tests and imaging procedures, Cushing’s disease was determined. Biopsy from the skin lesions revealed early period of pustular psoriasis.

Conclusion: The classic cutaneous manifestations of CS are; facial plethora, acne, purpura, cutaneous atrophy, hirsutism, vellous hypertrichosis, and wide purplish striae over the abdomen, flanks and upper arms. Acanthosis nigricans can occur but it is usually mild. In the literature, in our knowledges, there is no case together with Cushing’s syndrome and pustular psoriasis. This case is reported since these two conditions are rarely seen together.

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