Endocrine Abstracts

A 64-year old man presented to our endocrinology clinic with progressive lumbar pain that had developed two months earlier. He had undergone bilateral adrenalectomy for Cushing disease and two years later transsphenoidal resection for Nelson tumor. On physical examination, the patient had remarkable hyperpigmentation due to ACTH hypersecretion periorbital, peri-auricular and in the lower-neck region. These findings were clearly evident in his case due to the extensive facial vitiligo. Findings on bone scintigraphy were suggestive for metastatic lesions and biopsy confirmed our suspicion of bone-invasive pituitary carcinoma. The patient was referred to the oncology department as a candidate for immunotherapy but opted for palliative care because of his weakened general condition. This case highlights the fact that hypercortisolism induces a state of immunosuppression. After remission of Cushing’s syndrome, rebound immunity frequently results in overt autoimmune diseases. This immunological phenomenon has been described in both ACTH-dependent and -independent cases.