Raccah D, Zeitoun C, Lafforgue P, Lassmann-Vague V, Mallet B, Vialettes B, Weiller P J, Vague P
Service de Médecine Interne et de Nutrition, CHU Timone, Marseille.
Rev Med Interne. 1992 Jul-Aug;13(4):302-4. doi: 10.1016/s0248-8663(05)80307-8.
The anti-inflammatory effect of natural glucocorticoids is often overlooked, as shown by these two cases of inflammatory rheumatism flare-up which occurred after surgical treatment of Cushing's syndrome. The disorder in the first case was exacerbation of a probable rheumatoid arthritis; in the second case an unlabelled inflammatory rheumatism appeared in a context of postoperative corticotropic deficiency. In both cases a purely substitutive hydrocortisone therapy resulted in dramatic regression of the articular symptoms. It is well known that rheumatismal manifestations may occur in patients with slow adrenal failure. The determinant factor seems to be a glucocorticoid deficiency, either isolated or associated with others, since cortisol exerts and anti-inflammatory activity. In patients with corticotropic deficiency following surgical treatment of Cushing's disease, the endogenous corticosteroid therapy of hypercortisolism is interrupted, allowing the aggravation or emergence of inflammatory rheumatism.
天然糖皮质激素的抗炎作用常常被忽视，库欣综合征手术治疗后发生的这两例炎症性风湿病 flare-up 就表明了这一点。第一例患者的病情是可能存在的类风湿关节炎加重；第二例患者在术后促肾上腺皮质激素缺乏的情况下出现了未确诊的炎症性风湿病。在这两例中，单纯的氢化可的松替代疗法都使关节症状显著消退。众所周知，肾上腺功能减退缓慢的患者可能会出现风湿病表现。决定性因素似乎是糖皮质激素缺乏，无论是单独存在还是与其他因素相关，因为皮质醇具有抗炎活性。在库欣病手术治疗后出现促肾上腺皮质激素缺乏的患者中，高皮质醇血症的内源性皮质类固醇治疗被中断，从而导致炎症性风湿病加重或出现。
