Development of Rheumatoid Arthritis during Treatment of Cushing's Disease.
- Author:
Han Joo BAEK
1
;
Ki Chul SHIN
;
Yun Jong LEE
;
Seong Wook KANG
;
Eun Bong LEE
;
Yeong Wook SONG
Author Information
1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
- Publication Type:Case Report
- MeSH:
Arthralgia;
Arthritis, Rheumatoid*;
Brain;
Female;
Humans;
Hydrocortisone;
Ketoconazole;
Prednisolone;
Radiotherapy;
Recurrence;
Reference Values
- From:Korean Journal of Medicine
1998;55(2):245-249
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Exogenous glucocorticoid has anti-inflammatory effect to reduce symptoms and signs of rheumatoid arthritis. However there are few reports about the role of endogenous glucocorticoid in rheumatoid arthritis. Recently we experienced a case of rheumatoid arthritis developed in a female patient with Cushing's disease as her cortisol level decreased during medical management of hypercortisolemia. She underwent trans-sphenoidal surgery for Cushing's disease (pituitary microadenoma). Six years after surgery she had disease recurrence and received brain radiotherapy and ketoconazole medication. Four years later she developed seronegative rheumatoid arthritis. 24 hour urine cortisol level was below the normal value at that time. Polyarthralgia improved with prednisolone (5mg/day). But polyarthralgia was aggravated as cortisol level decreased below the normal value after prednisolone was discontinued. This case and previous reports suggest that the development and aggravation of rheumatoid arthritis is associated with relative cortisol deficiency, or alteration of balance between neuroendocrine system(hypothalamic- pituitary-adrenal axis) and inflammatory process.
