title: Overt immune dysfunction after Cushing's syndrome remission: a consecutive case series and review of the literature.
abstract: BACKGROUND
  Autoimmune diseases frequently improve during active Cushing's syndrome. Several studies have reported new onset or exacerbation of these conditions upon cortisol normalization.
  
  
  OBJECTIVE
  Our objective was to investigate the incidence and clinical characteristics of patients with autoimmune or allergic diseases after Cushing's syndrome remission.
  
  
  METHODS
  Consecutive cases of confirmed Cushing's syndrome were characterized. A review of the literature was conducted to identify previous descriptions of immune dysfunction upon remission and evidence of the hypothalamic-pituitary-adrenal axis influence on the immune system.
  
  
  RESULTS
  Among 66 patients who achieved Cushing's syndrome remission, the incidence of immune dysfunction was 16.7%, where eight cases (72.7%) were noted for the first time and three (27.3%) were exacerbated. All had an ACTH-dependent cause. Glucocorticoids reduce proinflammatory cytokines and interact with other transcription factors affecting T cell and mast cell survival.
  
  
  CONCLUSIONS
  Hypercortisolism induces a state of immunosuppression. After Cushing's syndrome remission, rebound immunity frequently results in overt conditions extending beyond thyroid dysfunction.
authors.affiliation: Department of Medicine, University Health Network, Toronto, Ontario, Canada M5G 2M9.
authors.forename: Filipe
authors.initials: F
authors.lastname: da Mota
authors.forename: Cathy
authors.initials: C
authors.lastname: Murray
authors.forename: Shereen
authors.initials: S
authors.lastname: Ezzat
mesh_terms: D000315:Adrenalectomy; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001249:Asthma / Q000209:etiology; D001327:Autoimmune Diseases / Q000209:etiology / Q000276:immunology; D003480:Cushing Syndrome / Q000150:complications / Q000276:immunology* / Q000601:surgery*; D004485:Eczema / Q000209:etiology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use; D006967:Hypersensitivity / Q000209:etiology / Q000276:immunology; D007654:Ketoconazole / Q000627:therapeutic use; D053685:Laser Therapy; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000209:etiology / Q000276:immunology; D012074:Remission Induction; D012393:Rosacea / Q000209:etiology; D012507:Sarcoidosis / Q000209:etiology; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use; D013959:Thyroid Diseases / Q000209:etiology; D014424:Turner Syndrome / Q000150:complications
chemical_list: D000891:Anti-Infective Agents, Local; D000935:Antifungal Agents; D013256:Steroids; D007654:Ketoconazole; D006854:Hydrocortisone