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Case report
Remitting seronegative symmetrical synovitis with pitting oedema after surgical remission of Cushing’s syndrome
  1. Hiroaki Iwasaki1,
  2. Hitomi Kanno2 and
  3. Shi-Xu Jiang3
  1. 1Department of Internal Medicine, Toshiba Rinkan Hospital, Sagamihara, Kanagawa, Japan
  2. 2Department of Urology, Toshiba Rinkan Hospital, Sagamihara, Kanagawa, Japan
  3. 3Department of Pathology, Toshiba Rinkan Hospital, Sagamihara, Kanagawa, Japan
  1. Correspondence to Dr Hiroaki Iwasaki; iwasaki.har{at}


A 64-year-old woman with refractory cellulitis in the lower legs was referred for inadequate glycaemic control. Physical examination revealed cushingoid features including central obesity. CT of the abdomen revealed a right adrenal mass that was positive on 131I-adosterol imaging. Findings on endocrine evaluation confirmed a diagnosis of Cushing’s syndrome, which was cured with a right adrenalectomy. Two months after surgery, the patient complained of pain and marked swelling of the hands during hydrocortisone replacement therapy (20 mg per day) given for postoperative adrenal insufficiency. Laboratory examination was unremarkable. However, contrast-enhanced T2-weighted MRI of the hands revealed enhanced signals surrounding the flexor tendons, leading to a diagnosis of remitting seronegative symmetrical synovitis with pitting oedema. Prednisolone (15 mg per day) was then initiated, and the symptoms disappeared within a few days. This case illustrates the possibility that successful treatment of Cushing’s syndrome may trigger emergence of a glucocorticoid-responsive disease.

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  • Contributors HI was the patient’s physician and diagnosed Cushing’s syndrome due to a right adrenocortical adenoma by endocrine evaluation. HI diagnosed RS3PE in the patient and provides prednisolone therapy, in addition to treating diabetes mellitus, hypertension and osteoporosis. HI was responsible for case description and literature review, and wrote the manuscript. HK was the surgeon who underwent the laparoscopic right adrenalectomy for the patient. S-XJ was the pathologist who performed the histological examinations of the patient’s resected specimens and participated in making and interpreting the results (figure 2D,E,F).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval This study was approved by the Ethic Committee of Toshiba Rinkan Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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