Background: Excessive level of cortisol in patients with Cushings disease (CD) can cause an immunosuppression. Therefore after resolution of hypercorticism the underline autoimmune disorders can appears.
Aim: We are presenting three cases of autoimmune disorders diagnosed in patients successfully treated for CD.
Results: Case 1: Woman, 37-year-old with confirmed panhypopituitarism after transsphenoidal adenomectomy (TSA) for CD in June 2013. Panhypopituitarism was replaced by hormonal therapy. Several months later she complained for arthralgia and painful erythematous nodules in soft tissues of shins. Erythema nodosum was diagnosed. After increasing the dose of hydrocortisone the lesions disappeared.
Case 2: Woman, 33-year-old In active state of CD pneumonia was diagnosed. She was treated by antibacterial therapy with resolution of symptoms. In May 2013 TSA has been done. Panhypopituitarism was compensated by hormonal therapy. Four months later she complained for caught, subfebrile temperature and appearance of painful erythematous nodules in soft tissues. After clinical evaluation pulmonary sarcoidosis and erythema nodosum were diagnosed. The dose of glucocorticoids was significantly increased and she felt herself better. Reduction of the dose has led to exacerbation of symptoms of sarcoidosis and erithema nodosum again.
Case 3: Woman, 43-year-old panhypopituitarism developed after TSA for CD in July 2011 and was compensated by hormonal therapy. Twelve months later the diffuse toxic goiter occurred. L-thyroxine was cancelled and methimazole was prescribed. Six months later thyroidectomy was done because of frequent relapse of thyrotoxicosis on low doses of methimazole accompanied with severe decompensation of secondary adrenal insufficiency.
Conclusion: There are limited reports of occurrence or relapse of underline autoimmune disorders after successful treatment for CD. The occurrence of sarcoidosis is very rare and not clearly understood. In case 2, more likely the sarcoidosis, but not pneumonia was in active state of disease.