A case of immune thrombocytopenia aggravated by therapy for hypercortisolism in adrenocortical carcinoma

Cushing's syndrome (CS) is characterized by excessive endogenous cortisol production and necessitates prompt intervention. We report a case of adrenocortical carcinoma (ACC) complicated by CS in a patient with a history of immune thrombocytopenia (ITP). Following treatment with metyrapone and surgical resection aimed at reducing cortisol levels, the patient experienced an ITP relapse. To our knowledge, this is the first report demonstrating the clinical impact of rapid cortisol fluctuations induced by CS treatment on ITP control. The patient required concurrent management with exogenous steroids to maintain platelet counts while correcting hypercortisolism. This case highlights the immunosuppressive role of endogenous cortisol and underscores the need for careful monitoring in patients with coexisting autoimmune disorders undergoing treatment for CS. Awareness of this interaction may inform individualized steroid tapering strategies and improve outcomes in similar clinical scenarios.