Sarcoidosis after surgically induced remission of Cushing's disease

To describe a rare case of sarcoidosis diagnosed after surgical resection of an adenoma in a patient with Cushing's disease.

We present a case report and discuss the only other similar case identified from the published medical literature.

In a 33-year-old woman with symptoms of cortisol excess (including progressive weight gain, proximal muscle weakness, ecchymoses, and amenorrhea), laboratory studies showed serum cortisol values consistent with Cushing's syndrome. After inferior petrosal sinus sampling, the patient underwent surgical resection of an adenoma in the right aspect of the anterior pituitary gland. Maintenance corticosteroid therapy was implemented, and the signs and symptoms of Cushing's disease began to resolve. Five months postoperatively, multiple erythematous lesions developed on the patient's arms and legs. Skin biopsy specimens demonstrated noncaseating granulomas, and sarcoidosis was diagnosed. Two months later, the lesions resolved spontaneously without therapy other than continued corticosteroid replacement.

Physicians should be aware that unusual postoperative symptoms in a patient who has undergone successful treatment of Cushing's syndrome may be attributable to the emergence of another corticosteroid-responsive disease such as sarcoidosis.