Session: OR21-HPA Axis: New Clinical Developments
Room 134 (Moscone Center)
The new onset/exacerbation of autoimmune diseases (AID) has been reported after remission of Cushing’s syndrome (CS), likely due to immune system reactivation after suppression induced by hypercortisolism. Aims of our study were to evaluate the prevalence and type of AID in a large cohort of patients with: 1) ACTH-omas and active CS vs other pituitary adenomas (PAs); 2) CS (various origins) during active disease vs remission.
Materials and Methods
116 patients (F:M = 95:21; age at diagnosis 41.2 ± 13.6 yr) with CS (23 adrenal, 89 pituitary, 4 ectopic origin) treated with surgical, medical or radiation therapy, with active disease or after remission, and 116 patients with other types of PAs matched for sex (F:M = 95:21) and age at diagnosis (42 ± 13.3 yr) from 3 tertiary care Italian Centers were enrolled in the study. Data were collected from clinical records and specific questionnaires administered to the patients.
A total of 35 patients (28 F) with CS (25 pituitary, 2 ectopic, 8 adrenal origin) suffered from AID, single in 30 cases (1 fibromyalgia, 1 psoriasic arthritis, 1 rheumatoid arthritis, 1 sieronegative arthritis; 1 Batelman’s purpura, 1 vasculitis, 1 nodosum erythema; 2 dermatitis, 4 psoriasis, 1 lichenoid pitiriasis, 1 alopecia aerata, 1 seborrheic eczema; 1 IBD; 7 Hashimoto’s thyroiditis, 4 Grave’s thyroiditis, 1 Riedel thyroiditis; 1 optic neuromyelitis), multiple in 5 cases (1 acute synovitis + thyroiditis; 1 psoriasis + psoriasic arthritis; 1 cutaneous lymphoma + IBD; 1 cutaneous and rheumatic SLE; 1 cholangitis + IBD + thyroiditis). AID appeared before CS in 12 cases: 3 resolved before CS, 5 persisted during active phase and CS’ remission, 2 improved during active phase but worsened after CS’ remission, 2 resolved after CS’ remission. In 10 cases AID appeared in the active phase of CS: 9 persisted but 1 resolved after CS’ remission. In 17 cases AID appeared only after CS’ partial/complete remission.
40 patients with PA (26 F) suffered from single AID (3 rheumatoid arthritis, 1 spondylitis anchylosans; 1 eczematoid dermatitis, 1 vitiligo, 6 psoriasis; 1 celiac disease, 4 IBD; 1 vasculitis; 19 thyroiditis, 2 type I diabetes; 1 IgA glomerulonephritis). AID activity did not correlate with hormonal status.
We provide results of the 1st comparative, largest study on AID in CS. AID’s prevalence was similar in ACTH-dependent (33%) and ACTH-independent (30.4%) CS. Frequency of AID was equal in pituitary CS and other type of PA. Overall, in CS and PA males were significantly more affected than females (relative prevalences affected/total: 21/42 for M, 54/190 for F), thyroiditis and psoriasis being the most common diseases. Hypercortisolism influenced AID’s evolution as the great majority of new cases/exacerbation of AID were registered after CS’s remission (confirming previous data), while hormonal status in other types of PA did not affect AID’s evolution.
Nothing to Disclose: FG, MD, CMS, MLZ, FP, IK, SG, EGGMG, EA
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