Endocrine Abstracts

Introduction: Psoriasis is a chronic, inflammatory and T-cell mediated autoimmune disease of skin. Its prevalence is 2–3%. It may improve due to immunesupressive effects of hypercortisolaemia during the active phase of Cushing’s syndrome (CS) and may exacerbate after treatment. The aim of this study was to investigate association of psoriasis with CS.

Methods: We prospectively followed 62 patients who had been diagnosed with CS between 2010 and 2014 in our clinic. Of the patients, 60% was Cushing disease (CD) (29 female, eight male) and 40% was ACTH-independent CS (20 female, five male). The patients were evaluated for psoriasis.

Results: The prevalence of psoriasis was 5% among our patients with CS. Psoriasis was diagnosed in three patients; two had pituitary adenoma and one had adrenal adenoma. Two were diagnosed before treatment of CD, and the other was diagnosed after 2 years following remission of ACTH-independent CS. The pathological evaluation of two patients with CD was reported as densely granulated corticotrophic adenoma and the pathological evaluation of the patient with ACTH-independent CS was reported as adrenocortical adenoma with nuclear pleomorphism and possible malignant behaviour. In the light of these findings, potential hypersecretory tumours should be considered.

Discussion: Endogenous hypercortisolism supresses inflammatory response and induces a state of immunesuppression. Once cortisol levels come back to normal following remission of CS, rebound response of immunity may result in exacerbation of autoimmune diseases like psoriasis. Prevalence of psoriasis is elevated in CS. If the patient is known to have a history of stress-responders psoriasis prior to surgery, we should evaluate the patient more carefully and frequently for exacerbation of psoriasis after remission of CS. Autoimmune diseases may exacerbate or may be newly diagnosed because of rebound immunity in remission of CS.