Unmasking of Sarcoidosis After Successful Management of Cushing's Syndrome

Cushing's syndrome is characterized by excessive glucocorticoid secretion leading to immunosuppression. The unmasking or aggravation of autoimmune diseases upon the normalization of cortisol levels after Cushing’s syndrome cure has been reported infrequently. The case of a 45-year-old woman who presented with an 11-month history of severe signs and symptoms of hypercortisolism is reported. Hormonal tests suggested the presence of adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome. Imaging studies detected an adrenal adenoma. The patient underwent laparoscopic adrenalectomy, and the mass was resected. Five months later the patient developed generalized arthralgias, malaise, a dry cough, and erythema nodosum. A diagnosis of sarcoidosis was confirmed by imaging and biopsy.