[Cushing's syndrome found during long-term glucocorticoid treatment of rheumatoid arthritis in an elderly woman].
A 69-year-old female patient had been treated with glucocorticoid for eight years because of rheumatoid arthritis. She showed characteristic Cushingoid features such as central obesity, moon face, and fragility of skin and vessels. She was disabled because of spinal compression fracture and muscle weakness. The blood pressure was 186/100 mmHg and the laboratory tests revealed serum K: 2.8 mEq/l, WBC: 15, 510/mm3, total cholesterol: 310 mg/dl. These suggested that she had iatrogenic Cushing's syndrome. After discontinuation of glucocorticoid, however, the serum cortisol level remained high. This fact prompted us to conduct further examinations for Cushing's syndrome. Oral dexamethasone administration did not suppress the plasma cortisol level and a left adrenal adenoma was found on abdominal CT scan. Because of the presence of bleeding diathesis, operation for adenoma was contraindicated. Though we tried to treat her with metyrapone, trilostane or opeprim (OP'-DDD), we had to abandon specific treatment because of severe side effects such as acute adrenal dysfunction and gastrointestinal problems. Decrease in the endogenous cortisol level after metyrapone treatment caused exacerbation of symptoms of rheumatoid arthritis. This is a peculiar case in which the long-term administration of glucocorticoid for rheumatoid arthritis might have concealed Cushing's syndrome, and conversely the increased intrinsic adrenal steroid hormone might have suppressed the activity of the rheumatoid arthritis.
Nakamoto
Y
Y
Department of Geriatric Medicine, Osaka University Medical School.
Tabuchi
Y
Y
Saeki
S
S
Mikami
H
H
Ogihara
T
T
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D003480:Cushing Syndrome / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D011239:Prednisolone / Q000008:administration & dosage* / Q000627:therapeutic use
D011239:Prednisolone