EXACERBATION OF RHEUMATOID-ARTHRITIS AFTER REMOVAL OF ADRENAL ADENOMAIN CUSHINGS-SYNDROME

A 46-year-old woman with rheumatoid arthritis had been on non-steroida l antiinflammatory agents for eighteen years until she developed cushi ngoid features and hypertension resistant to antihypertensive drugs. S he had high plasma cortisol and 24 h urinary 17-hydroxycorticosteroids (17HCS) which were not suppressed by 8 mg dexamethasone per day for t wo days. The circadian rhythm of plasma cortisol was absent and plasma ACTH concentrations were suppressed before and after intravenous admi nistration of CRH. Abdominal computed tomography demonstrated a tumor (3.0 x 3.0 x 2.3 cm) in the right adrenal gland and a I-131-6 beta-19- nor-methylcholesterol scan revealed marked uptake on the same side. Th e patient underwent a right adrenalectomy and the diagnosis of a corti sol secreting benign adenoma was histologically confirmed. Blood press ure declined and cushingoid features regressed, but three months after the operation and while the patient was on replacement, she complaine d of pain on motion, marked tenderness and swelling of fingers, wrists , elbows, knees and foot joints, and had very high rheumatoid factors. Treatment with immunosuppressive drugs and oral and intraarticular ad ministration of glucocorticoids were necessary to relieve the clinical symptoms of rheumatoid arthritis. In summary, we report a patient wit h rheumatoid arthritis and Gushing's syndrome due to an adrenal adenom a, in whom rheumatoid arthritis was exacerbated after curing the Gushi ng's syndrome. This suggests that it is imperative to follow the devel opment and/or course of autoimmune diseases after the treatment of Gus hing's syndrome.