Diernaes Jon E F, Bygum Anette, Poulsen Per L
Department of Dermatology, Aarhus University Hospital , Aarhus, Denmark.
Department of Dermatology and Allergy Centre, Odense University Hospital , Odense, Denmark.
Dermatoendocrinol. 2016 Jun 7;8(1):e983688. doi: 10.4161/derm.29855. eCollection 2016 Jan-Dec.
We present a patient with Cushing disease apparently suppressing sarcoidosis, which was unmasked following surgical resection of a pituitary adrenocorticotropin (ACTH)-producing microadenoma. Case report and a short review of the literature published in this area. A 46-year-old Caucasian woman presented with symptoms of hypercortisolism such as progressive weight gain, Cushingoid appearance, proximal myopathy, easy bruising, and amenorrhea. Blood testing including inferior petrosal sinus sampling uncovered an ACTH-producing microadenoma in the right aspect of the anterior pituitary gland for which the patient underwent transphenoidal resection. Maintenance corticosteroid therapy was implemented, and the signs and symptoms of Cushing disease began to resolve. Three months after surgery, multiple erythematous painful nodules developed on the patient's arms. Erythema nodosum (EN) was diagnosed clinically and a suspicion of underlying sarcoidosis was substantiated by lung imaging and elevated plasma interleukin (IL)-2 receptor. One month later, the lesions spontaneously resolved without therapy other than maintenance glucocorticoid replacement. Physicians should be aware that patients undergoing successful treatment of Cushing syndrome may have a flare-up or emergence of a corticosteroid-responsive disease.
我们报告一例库欣病患者，其病情明显抑制了结节病，在手术切除产生促肾上腺皮质激素（ACTH）的垂体微腺瘤后，结节病得以显现。病例报告及该领域已发表文献的简短综述。一名46岁的白人女性出现皮质醇增多症症状，如进行性体重增加、库欣面容、近端肌病、易瘀伤和闭经。包括岩下窦采血在内的血液检查发现垂体前叶右侧有一个产生ACTH的微腺瘤，患者因此接受了经蝶窦切除术。实施了维持性皮质类固醇治疗，库欣病的体征和症状开始缓解。术后三个月，患者手臂上出现多个疼痛性红斑结节。临床诊断为结节性红斑（EN），肺部影像学检查和血浆白细胞介素（IL）-2受体升高证实了潜在结节病的怀疑。一个月后，除维持糖皮质激素替代治疗外，病变未经其他治疗即自行消退。医生应意识到，成功治疗库欣综合征的患者可能会出现皮质类固醇反应性疾病的发作或新发病例。
