Exacerbations of Graves' disease after unilateral adrenalectomy for Cushing's syndrome.
Cushing's syndrome is characterized by endogenously increased production of glucocorticoids. The activity of immune system is regulated mainly by two systems in the body. Glucocorticoids and NF-kappaB counteract the effects of each other on the immune system. It has been reported that immune response is exaggerated after the amelioration of Cushing's syndrome. We report a rare case of exacerbation of Graves' disease after unilateral adrenalectomy for Cusing's syndrome. A 50-yr-obese woman with hypertension, dyslipidemia, impaired glucose tolerance and insulin resistance wasadmitted to outpatients clinic of endocrinology. The results of evaluation of glucocorticoids metabolism and adrenal magnetic resonance imaging revealed the Cusing's syndrome. We also assessed thyroid function tests because of the diagnosis of goiter and thyroid hormone replacement in her medical history, and the presence of exophthalmia and tachycardia in examination. Althoug TSH level was detected at the lower border of normal range, free T4 and free T3 were in normal range and autoantibody of thyroidal peroxidase and thyroglobulin was higer than normal reference range. An operation was performed and a mass was removed from her left adrenal gland. The pathologic examination confirmed adrenal adenoma. She was re-admitted to the outpatient clinic 9 months after with complaints of palpitation, malaise and weight loss. Tests carried out to determine the thyroid function revealed Graves' disease. We prescribed propylthiouracil and beta-blocker treatment.
Arikan
E
E
Medical Faculty of Trakya University, Edirne, Turkey. earikan@trakya.edu.tr
Guldiken
S
S
Altun
B Ugur
BU
Kara
M
M
Tugrul
A
A
D000315:Adrenalectomy / Q000009:adverse effects*; D003480:Cushing Syndrome / Q000601:surgery*; D018450:Disease Progression; D005221:Fatigue; D005260:Female; D007839:Functional Laterality; D006111:Graves Disease / Q000209:etiology* / Q000473:pathology*; D006339:Heart Rate; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009765:Obesity; D012720:Severity of Illness Index; D015431:Weight Loss
N Engl J Med. 1990 Jun 14;322(24):1708-12
2342537
Clin Endocrinol (Oxf). 2000 Jul;53(1):13-9
10931076
Lancet. 2001 Mar 10;357(9258):783-91
11253984
Br J Rheumatol. 1998 Jul;37(7):804-5
9714369
Clin Endocrinol (Oxf). 1990 Dec;33(6):777-86
2128925
Endocr Rev. 1999 Aug;20(4):435-59
10453354
Endocr J. 1995 Apr;42(2):219-23
7627266
Clin Endocrinol (Oxf). 1998 May;48(5):670-2
9666882
Acta Endocrinol (Copenh). 1989 Jul;121(1):95-100
2500822
Am J Med Sci. 2002 Mar;323(3):162-5
11908863
J Psychosom Res. 2002 Oct;53(4):865-71
12377295
J Rheumatol. 1995 Oct;22(10):1964-6
8992000
Psychoneuroendocrinology. 1996 Oct;21(7):599-608
9044443