CUSHINGS-SYNDROME COMPLICATED BY MULTIPLE OPPORTUNISTIC INFECTIONS

The case history of a 56-year-old man is described who suffered from s evere adrenocorticotrophic hormone (ACTH)-dependent Gushing's syndrome . The clinical course was complicated by simultaneous infections with Pneumocystis carinii, Staphylococcus aureus, Candida albicans, Aspergi llus fumigatus and Herpes simplex, which proved to be fatal. A study o f the literature shows that opportunistic infections in endogenous Gus hing's syndrome are associated with severe cortisol excess and carry a high mortality. Opportunistic infections are most prevalent in the ec topic ACTH syndrome, explained by the very high plasma cortisol concen trations in this condition. Infections with Aspergillus species, Crypt occus neoformans, Pneumocystis carinii and Nocardia asteroides predomi nated. Gushing's syndrome with a very high plasma cortisol concentrati on causes a severe immunocompromized state. Prompt evaluation of the c ause of the hypercortisolism, initiation of cortisol lowering therapy, primary prophylaxis for Pneumocystis carinii infection when plasma co rtisol exceeds 2500 nmol L(-1 )and a search for concomitant infectious disease is recommended. (C) 1998, Editrice Kurtis.