A rare case study published in JCEM Case Reports details the first known instance of a decades-dormant hormonal disorder, Cyclic Cushing Syndrome (CS), relapsing after a patient contracted COVID-19 and received standard glucocorticoid treatment. The relapse occurred after a remarkable 19-year period of remission, leading researchers to suggest that the stress of the infection and the administered steroids may have triggered a rare “positive feedback” loop, reigniting the life-threatening condition.
The case highlights the critical need for long-term patient follow-up and caution when administering steroids to individuals with a history of the disorder. The patient, a 49-year-old man, had initially been diagnosed with adrenocorticotropic hormone (ACTH)-dependent CS at age 30 but achieved spontaneous remission after initial treatment with steroidogenesis inhibitors (trilostane and mitotane).
A subtype of Cushing’s syndrome, patients with CS have phases of cortisol excess—hypercortisolemia–alternating with phases of normal and low cortisol. Each of these phases can vary from days to even months or years.
For nearly two decades, this patient’s condition remained stable, with no cushingoid symptoms or abnormal hormone levels noted during annual checkups.
Signals of relapse in a dormant endocrine disease after infection and steroid exposure