Schaefer S, Meyer S, Brueck C C, Weber M, Luedecke D, Wagner H J, Kann P H
Philipps University Marburg, Marburg.
Exp Clin Endocrinol Diabetes. 2010 Mar;118(3):147-50. doi: 10.1055/s-0028-1087179. Epub 2010 Feb 16.
Cushing's syndrome is characterized by excessive elevation of glucocorticoid concentrations. In rare cases, the treatment of Cushing's syndrome may result in unmasking or aggravation of diseases responsive to glucocorticoid medication. We report two cases of sarcoidosis following Cushing's syndrome. A 43 year-old male developed cutaneous sarcoidosis and mediastinal lymphadenopathy after resection of an ACTH-secreting pituitary microadenoma. A 32 year-old female showed cutaneous sarcoidosis, arthralgia, mediastinal lymphadenopathy and elevation of angiotensin-converting enzyme and interleukin 2-receptor concentrations after traumatic adrenal bleeding, which ceased formerly undiagnosed hypercortisolism caused by an adrenal adenoma. Sarcoidosis seems to be a rare sequel following the treatment of hypercortisolism. Skin affections were present and suggestive for the diagnosis in all reported cases. As some cases are probably missed when skin affections are lacking, a more frequent evaluation of patients after Cushing's syndrome for the possible diagnosis of sarcoidosis might be necessary.
库欣综合征的特征是糖皮质激素浓度过度升高。在罕见情况下,库欣综合征的治疗可能会导致对糖皮质激素药物有反应的疾病被暴露或加重。我们报告两例库欣综合征后发生结节病的病例。一名43岁男性在切除分泌促肾上腺皮质激素的垂体微腺瘤后出现皮肤结节病和纵隔淋巴结病。一名32岁女性在创伤性肾上腺出血后出现皮肤结节病、关节痛、纵隔淋巴结病以及血管紧张素转换酶和白细胞介素2受体浓度升高,此前由肾上腺腺瘤引起的未被诊断的高皮质醇血症得以缓解。结节病似乎是高皮质醇血症治疗后的一种罕见后遗症。在所有报告的病例中均存在皮肤病变,这对诊断具有提示作用。由于当缺乏皮肤病变时可能会漏诊一些病例,因此对库欣综合征患者进行更频繁的评估以排查结节病的可能诊断可能是必要的。