From Lewis S Blevins Jr, MD – I’ve seen a few instances over my career of auto-immune and inflammatory disorders flaring or becoming more apparent after someone has entered remission for Cushing’s syndrome. In each circumstance, there were no prior indicators of underlying disease. These disorders have included: Systemic Lupus, Rheumatoid Arthritis, Mixed Connective Tissue Disease, Temporal Arteritis, and, now, Psoriatic Arthritis. In each instance, the high doses of cortisol produced by the adrenal glands have “treated” or checked the underlying inflammatory condition.
When patients undergo surgery and enter remission, and are treated with “replacement” doses of steroids until the hypothalamic-pituitary-adrenal axis recovers, inflammatory conditions come out from under the suppression and can rage. Many patients develop steroid withdrawal symptoms and signs as their bodies adjust to having normal levels of steroids after successful surgery for Cushing’s. It can be difficult to discern who among those feeling poorly in remission has the emergence of an inflammatory condition instead of steroid withdrawal. In my experience, it is always those whose symptoms are out of proportion to those of all other similar patients.
This is where lots of experience comes in handy as patients are best examined against a anecdotal treatment database if you will. In my recent patient, the very high Sed Rate in the absence of positive RF and ANA indicated something was up. We suggested referral to a Rheumatologist who made the diagnosis.
This is a good example as to how doctors and patients listening to one another can result in important discoveries and better health.
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