Case of Cyclic Cushing’s Disease with Improvement of Psoriatic Skin Lesions During a Period of Hypercortisolemia

• Published in: Journal of the Endocrine Society 2021-07, Vol.5 (7)
• Main Authors: Nakatake, Nobuhiro, Hiraoka, Fumihiro, Yano, Shigetoshi, Hara, Takeshi, Matsubayashi, Sunao
• Format: Article
• Language: English
• Subjects: ACTH; Case Report; Corticosteroids; Corticotropin releasing hormone; Psoriasis; Skin
• ISSN: 2472-1972; 2472-1972
• DOI: 10.1210/jendso/bvab058

Abstract Cushing’s syndrome (CS) is known to involve periodic cortisol secretion in some patients. It has also been demonstrated that resolution of cortisol hypersecretion in CS may cause autoimmune-related disease to become apparent. At least 3 cases of psoriasis that became apparent after resolution of hypercortisolism in CS have been reported. We describe a 45-year-old man with cyclic Cushing’s disease in whom psoriasis vulgaris, an autoimmune-related disease, was ameliorated during a period of hypercortisolemia. He had complained of intermittent sensations of “whole-body swelling” and improvement of his psoriatic skin lesions, which lasted 2 to 3 weeks at 2- to 3-month intervals over several years. During a 2-week hospitalization for endocrine investigations, an episode of hypercortisolemia appeared unexpectedly. During this time period, the peak serum cortisol level reached 75.7 µg/mL (adrenocorticotropic hormone level, 585 pg/mL) and 24-hour urinary free cortisol reached 10 500 µg/day. A diagnosis of Cushing’s disease was made based on a markedly elevated urinary free cortisol level, an adequate increase in adrenocorticotropic hormone level in response to corticotropin-releasing hormone stimulation, and the presence of a giant pituitary tumor with a maximum diameter of approximately 4 cm. Interestingly, during this time period, there was a marked improvement in the psoriatic skin lesions and whole-body swelling sensations.