Cushing's disease presenting with recurrent abscesses followed by post-remission hyperthyroidism

Area of Science:

• Endocrinology
• Immunology

Background:

• Recurrent severe infections can indicate hypercortisolaemia (Cushing's syndrome).
• Chronic hypercortisolism leads to significant morbidity and can complicate diagnostic testing.
• Successful treatment of hypercortisolaemia may unmask or trigger autoimmune diseases.

Purpose of the Study:

• To report a case of hyperthyroidism developing after Cushing's disease treatment.
• To highlight the association between hypercortisolaemia treatment and autoimmune disease onset.
• To emphasize the importance of considering autoimmune sequelae post-treatment.

Main Methods:

• Case report of a 59-year-old woman with Cushing's disease.
• Hormonal assessments, bilateral inferior petrosal sinus sampling, and transsphenoidal surgery.
• Diagnosis and management of subsequent hyperthyroidism (Graves' disease) with radioiodine therapy.

Main Results:

• The patient with Cushing's disease developed hyperthyroidism post-surgery.
• Graves' disease was diagnosed, despite negative anti-thyroid stimulating hormone antibodies initially.
• Successful treatment resolved hyperthyroidism, infections, and abscesses.

Conclusions:

• Clinical manifestations of hypercortisolaemia can be non-specific.
• Treatment of hypercortisolaemia may precipitate autoimmune disorders.
• Awareness of this association is crucial for patient management.