Tuesday, December 6, 2011

Overt immune dysfunction after Cushing's syndrome remission: a consecutive case series and review of the literature

J Clin Endocrinol Metab. 2011 Oct;96(10):E1670-4. Epub 2011 Aug 3.

Overt immune dysfunction after Cushing's syndrome remission: a consecutive case series and review of the literature.

Source

Department of Medicine, University Health Network, Toronto, Ontario, Canada M5G 2M9.

Abstract

CONTEXT:

Autoimmune diseases frequently improve during active Cushing's syndrome. Several studies have reported new onset or exacerbation of these conditions upon cortisol normalization.

OBJECTIVE:

Our objective was to investigate the incidence and clinical characteristics of patients with autoimmune or allergic diseases after Cushing's syndrome remission.

METHODS:

Consecutive cases of confirmed Cushing's syndrome were characterized. A review of the literature was conducted to identify previous descriptions of immune dysfunction upon remission and evidence of the hypothalamic-pituitary-adrenal axis influence on the immune system.

RESULTS:

Among 66 patients who achieved Cushing's syndrome remission, the incidence of immune dysfunction was 16.7%, where eight cases (72.7%) were noted for the first time and three (27.3%) were exacerbated. All had an ACTH-dependent cause. Glucocorticoids reduce proinflammatory cytokines and interact with other transcription factors affecting T cell and mast cell survival.

CONCLUSION:

Hypercortisolism induces a state of immunosuppression. After Cushing's syndrome remission, rebound immunity frequently results in overt conditions extending beyond thyroid dysfunction.

from http://www.ncbi.nlm.nih.gov/pubmed/21816785