Auto-immune and inflammatory disorders in Cushing’s syndrome

From Lewis S Blevins Jr, MD  –  I’ve seen a few instances over my career of auto-immune and inflammatory disorders flaring or becoming more apparent after someone has entered remission for Cushing’s syndrome. In each circumstance, there were no prior indicators of underlying disease. These disorders have included: Systemic Lupus, Rheumatoid Arthritis, Mixed Connective Tissue Disease, Temporal Arteritis, and, now, Psoriatic Arthritis. In each instance, the high doses of cortisol produced by the adrenal glands have “treated” or checked the underlying inflammatory condition.

When patients undergo surgery and enter remission, and are treated with “replacement” doses of steroids until the hypothalamic-pituitary-adrenal axis recovers, inflammatory conditions come out from under the suppression and can rage. Many patients develop steroid withdrawal symptoms and signs as their bodies adjust to having normal levels of steroids after successful surgery for Cushing’s. It can be difficult to discern who among those feeling poorly in remission has the emergence of an inflammatory condition instead of steroid withdrawal. In my experience, it is always those whose symptoms are out of proportion to those of all other similar patients.

This is where lots of experience comes in handy as patients are best examined against a anecdotal treatment database if you will. In my recent patient, the very high Sed Rate in the absence of positive RF and ANA indicated something was up. We suggested referral to a Rheumatologist who made the diagnosis.

This is a good example as to how doctors and patients listening to one another can result in important discoveries and better health.

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  1. I already have a diagnosis of Rheumatoid Arthritis & Cushing’s disease, I’m having surgery to remove a 8mm tumour in September & am a bit worried as to what my RA will do following surgery.

    • Pauline. Just ensure your surgeon knows you already have RA so they can commence you on steroid supplements before surgery. Good luck 🙂

  2. I had my pituitary gland removed 17 months ago. 3 months ago i ended up in hospital with Full on body pain, every muscle, every bone. I thought my cortisol may have crashed so presented to ED. My cortisol was fine. But my ANA was 1:160 and my ESR was 70. GP said thats not high enough to indicate anything. My fatigue levels are so through the roof my limit of doing anything without a rest is around 10 minutes. This significantly impacts on my daily living. I find it interesting that Autoimmune disorders can be associated with cushings, as my doctors dont see a connection.


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