Associations Between Psoriasis and Endocrine Diagnoses in a Tertiary-Center Electronic Health Record Database: A Cross-Sectional Study

Abstract

Purpose

Psoriasis is associated with systemic comorbidities such as cardiovascular disease. The purpose of this study is to assess whether patients with psoriasis are more likely to also have endocrine disorders.

Patients and Methods

Using the Vanderbilt University Medical Center Synthetic Derivative, a de-identified database of more than 3.4 million patients, a cross-sectional study was conducted. PheWAS codes were used to identify patients with specific diagnoses.

Results

The control cohort consisted of 3389683 patients (54.9% female) and the psoriasis cohort consisted of 10855 patients (55.5% female). The prevalence of several endocrine disorders was found to be higher in those with psoriasis than without, including Cushing’s disease (0.322% vs 0.056%, age-adjusted odds ratio = 5.078, 95% CI = 3.650–7.066, p < 0.001), adrenal insufficiency (1.179% vs 0.225%, age-adjusted odds ratio = 4.388, 95% CI = 3.680–5.232, p < 0.001), hypothyroidism (10.567% vs 2.373%, age-adjusted odds ratio = 3.839, 95% CI = 3.607–4.085, p < 0.001), hyperthyroidism (1.704% vs 0.422%, age-adjusted odds ratio = 3.378, 95% CI = 2.919–3.910, p < 0.001), etc.

Conclusion

These results suggest that patients with psoriasis may also be at risk for endocrine dysfunction. The consequences of systemic inflammation in patients with psoriasis may extend beyond metabolic disorders such as cardiovascular disease, and further investigation into the association between endocrine disorders and psoriasis may lead to improvements in the clinical management of the latter.

Introduction

Psoriasis is a chronic systemic inflammatory disease that most commonly presents as pink to erythematous scaly plaques on the skin, affecting around 3% of individuals in the United States.^1,2 Although newer systemic therapies may improve long-term prognosis, patients with psoriasis still face a higher burden of other comorbidities such as metabolic syndrome, obesity, cardiovascular disease, and cerebrovascular disease.^3–6 In people with psoriasis, the risk of metabolic syndrome has been measured at two times that of the general population.⁷ Accordingly, an association has been established between psoriasis and Type II diabetes (T2DM).^8–12

In addition to these comorbidities, endocrine dysfunction has also been previously studied in patients with psoriasis. A meta-analysis found that the risk of hypothyroidism and hyperthyroidism in patients with psoriasis was greater than in patients without psoriasis (RR: 1.42, 95% CI: 1.29–1.57 and RR: 1.22, 95% CI: 1.14–1.32 respectively).¹³ A recent cross-sectional study of 119 patients with psoriasis also demonstrated that nearly 40% of these subjects exhibited thyroid dysfunction.¹⁴ While dysfunction of the thyroid gland in patients with psoriasis has been investigated, disorders of other endocrine glands in this population remain relatively unexplored. In terms of the adrenal gland, one study found that PsA (psoriatic arthritis), but not psoriasis, was significantly associated with primary adrenal insufficiency (odds ratio = 2.2, 95% CI = 1.07–4.5).¹⁵ Another study found a significant association between psoriasis and polycystic ovarian syndrome (odds ratio = 6.66, 95% CI = 2.95–15.07).¹⁶ Studies assessing the prevalence of T1DM and hyperparathyroidism in patients with psoriasis were not found.

While hypothyroidism and hyperthyroidism have been extensively investigated in patients with psoriasis, other endocrine disorders remain relatively unstudied in this population.¹³ As other endocrine diseases can of course cause additional threats to health, it is important to assess patients for these conditions appropriately.¹⁷ Patients with psoriasis in particular have higher mortality rates that are attributed partially to endocrine and metabolic causes.¹⁸ Thus, the significance of understanding the possible association between psoriasis and endocrine dysfunction remains crucial. In the present study, the prevalence of common endocrine disorders in greater than 10,000 patients with psoriasis has been quantified.

Materials and Methods

A cross-sectional study was conducted using the Synthetic Derivative (SD), a de-identified database of Vanderbilt University Medical Center consisting of almost 4 million patients. Participants 18 and above were included in this study. Demographic information, including age, race, and ethnicity, were collected from this database to characterize the study population. Phenome-wide association study code, or PheWAS code 696.4 for psoriasis was used to establish the cohort of patients diagnosed with psoriasis. The control cohort was established by excluding any patient record with the PheWAS code 696.4. The following PheWAS codes were also used to determine whether patients were diagnosed with endocrine disorders: 255.2 (adrenal hypofunction), 255.11 (Cushing’s syndrome), 244 (hypothyroidism), 242 (thyrotoxicosis with or without goiter), 250.1 (Type 1 diabetes), 250.2 (Type 2 diabetes), 252.1 (hyperparathyroidism), 256.4 (polycystic ovaries), 245.1 (chronic lymphocytic thyroiditis), 242.1 (Graves’ disease), 227.1 (benign neoplasm of adrenal gland), 226 (benign neoplasm of thyroid gland), 227.2 (benign neoplasm of parathyroid gland), and 227.3 [benign neoplasm of pituitary gland and craniopharyngeal duct (pouch)]. All information was extracted as of October 25, 2025.

The SD only permits review of individual-level data in sample sizes of 10,000 or less. As the sample sizes observed were much larger, data were analyzed in aggregate. To determine age-adjusted odds ratios, subjects were sorted into three age categories: 18–44 years, 45–64 years, and 65 years and older. When conducting the analysis for hyperparathyroidism (PheWAS code 252.1), patients with PheWAS code 588.2 [secondary hyperparathyroidism (of renal origin)] were excluded to examine the prevalence of primary hyperparathyroidism as accurately as possible. However, these patients were included when analyzing the prevalence of any one endocrine abnormality to prevent the exclusion of patients with type I diabetes mellitus (T1DM), type II diabetes mellitus (T2DM), or other conditions. The analysis for the prevalence of polycystic ovarian syndrome (PCOS) only included females.

Age-adjusted odds ratios and gender-adjusted odds ratios with 95% confidence intervals were calculated with the Cochran-Mantel-Haenszel test. A p-value of <0.05 was determined to be statistically significant. SPSS and Excel version 16.104 were used for statistical analysis and figure creation.

Results

Characteristics of Study Population

The study included 3,400,538 patients in total, with an overall psoriasis prevalence of 0.32% (Table 1). It should be noted that the SD is updated monthly, and the number of patients within this database continues to increase.¹⁹

Table 1.

Study Population Characteristics

	Control Cohort	Psoriasis Cohort
Total no. of subjects	3389683 (54.91% female)	10855 (55.50% female)
Racial demographics	African American – 8.74% Asian – 1.22% Caucasian – 58.69% Hispanic – 3.45% Multiple – 0.41% Native American – 0.11% Other – 0.47% Unknown – 26.93%	African American – 4.85% Asian – 1.17% Caucasian – 83.02% Hispanic – 2.03% Multiple – 0.34% Native American – 0.12% Other – 0.30% Unknown – 8.17%
No. of subjects aged 18–44	1,354,308 (54.61% female)	1834 (58.07% female)
No. of subjects aged 45–64	899,907 (56.21% female)	3584 (54.66% female)
No. of subjects aged 65+	1,135,468 (54.23% female)	5437 (55.18% female)

Note: The demographics of the control and psoriasis cohorts from the SD database are shown.

Abbreviations: BMI, body mass index; HPA, hypothalamic-pituitary-adrenal; PCOS, polycystic ovarian syndrome; PheWAS, Phenome-wide association studies; PsA, psoriatic arthritis; PTH, parathyroid hormone; SD, Synthetic Derivative; T1DM, Type I diabetes mellitus; T2DM, Type II diabetes mellitus.

Prevalence of Endocrine Disorders

The prevalence of the following endocrine disorders within this study population were calculated manually: adrenal insufficiency, Cushing’s syndrome, hypothyroidism, hyperthyroidism, primary hyperparathyroidism, T1DM, T2DM, and PCOS (Figure 1). For each of these endocrine disorders, the prevalence was numerically higher in the psoriasis cohort compared to the control cohort. Additionally, the diagnosis of psoriasis was found to be significantly associated with the diagnosis of adrenal insufficiency (age-adjusted odds ratio = 4.388, 95% CI = 3.680–5.232), Cushing’s syndrome (age-adjusted odds ratio = 5.078, 95% CI = 3.650–7.066), hypothyroidism (age-adjusted odds ratio = 3.839, 95% CI = 3.607–4.085), hyperthyroidism (age-adjusted odds ratio = 3.378, 95% CI = 2.919–3.910), primary hyperparathyroidism (age-adjusted odds ratio = 3.601, 95% CI = 2.963–4.376), T1DM (age-adjusted odds ratio = 3.354, 95% CI = 3.045–3.694), T2DM (age-adjusted odds ratio = 3.181, 95% CI = 3.009–3.362), PCOS (age-adjusted odds ratio = 4.240, 95% CI = 3.446–5.216), as well as at least one of these endocrine disorders (age-adjusted odds ratio = 3.469, 95% CI = 3.313–3.633), all having a p < 0.001, as shown in Figure 2. To ensure that sex was not a confounding factor, sex-adjusted odds ratios were also calculated using the Cochran-Mantel-Haenszel test (Supplementary Table 1).

Figure 1.

Prevalence of endocrine disorders in each cohort. The prevalence of endocrine disorders are shown, with black bars representing the control cohort and gray bars representing the psoriasis cohort. Here, T1DM refers to Type 1 diabetes mellitus, T2DM refers to Type 2 diabetes mellitus, and PCOS refers to polycystic ovarian syndrome. “Any endocrine abnormality” refers to the presence of at least one of the following: adrenal insufficiency, Cushing’s syndrome, hypothyroidism, hyperthyroidism, primary hyperparathyroidism, T1DM, T2DM, or PCOS.

Figure 2.

Age-adjusted odds ratios showing the association between psoriasis and specific endocrine disorders. The blue dot represents the odds ratio and the error bars represent the 95% confidence interval. Here, T1DM refers to Type 1 diabetes mellitus, T2DM refers to Type 2 diabetes mellitus, and PCOS refers to polycystic ovarian syndrome. “Any endocrine abnormality” refers to the presence of at least one of the following: adrenal insufficiency, Cushing’s syndrome, hypothyroidism, hyperthyroidism, primary hyperparathyroidism, T1DM, T2DM, or PCOS.

Prevalence of Thyroid Disorders

After noting the high prevalence of hypothyroidism in patients with psoriasis (10.57%) compared to patients without psoriasis (2.37%), the prevalence of chronic lymphocytic thyroiditis (or Hashimoto’s thyroiditis) was examined. The prevalence of this condition was 1.161% in patients with psoriasis versus 0.218% in patients without psoriasis. This association was also found to be statistically significant (age-adjusted odds ratio = 4.079, 95% CI = 3.944–5.623, p < 0.001). Interestingly, this association diminished drastically when controlling for hypothyroidism, with an age-adjusted odds ratio of 1.700 (95% confidence interval of 1.386–2.085, p < 0.001). Further, the association between psoriasis and hypothyroidism (age-adjusted odds ratio = 3.839, 95% CI = 3.607–4.085, p < 0.001) remained comparable when patients with chronic lymphocytic thyroiditis were excluded from those diagnosed with hypothyroidism (age-adjusted odds ratio = 3.693, 95% CI = 3.460–3.941, p < 0.001), evidenced by overlapping confidence intervals.

A similar and more extreme trend was observed when examining the association of psoriasis and Graves’ disease. The prevalence of Graves’ disease in the psoriasis cohort was 0.580% compared to 0.195% in the control cohort, and a statistically significant association between psoriasis and Graves’ disease was noted (age-adjusted odds ratio = 2.569, 95% CI = 2.011–3.283, p < 0.001). However, when controlling for hyperthyroidism, patients with psoriasis were less likely to have Graves’ disease compared to patients without psoriasis (age-adjusted odds ratio: 0.638, 95% CI = 0.004–0.471, p = 0.004). The association between hyperthyroidism and psoriasis (age-adjusted odds ratio = 3.378, 95% CI = 2.919–3.910, p < 0.001) was maintained when patients with Graves’ disease were excluded from those diagnosed with hyperthyroidism (age-adjusted odds ratio = 4.135, 95% CI = 3.459–4.945, p < 0.001), evidenced by overlapping confidence intervals.

Prevalence of Benign Endocrine Neoplasms

To investigate possible etiologies of the endocrine abnormalities noted in patients with psoriasis, the prevalence of benign endocrine neoplasms was also assessed. Hormone-secreting tumors such as parathyroid adenomas are usually benign, and thus the corresponding PheWAS codes were utilized for this analysis as described in the Methods section.²⁰ The prevalence of benign neoplasms arising from the adrenal gland, thyroid gland, parathyroid gland, and pituitary gland were all found to be higher in patients with psoriasis compared with patients without psoriasis (Figure 3). Moreover, the diagnosis of psoriasis was found to be significantly associated with the diagnosis of a benign adrenal neoplasm (age-adjusted odds ratio = 2.905, 95% CI = 2.048–4.120, p < 0.001), benign thyroid neoplasm (age-adjusted odds ratio = 2.703, 95% CI = 1.978–3.694), benign parathyroid neoplasm (age-adjusted odds ratio = 2.654, 95% CI = 1.802–3.910, p < 0.001), and benign pituitary or craniopharyngeal neoplasm (age-adjusted odds ratio = 2.224, 95% CI = 1.561–3.169), p < 0.001) as shown in Figure 4. Sex-adjusted odds ratios were also calculated using the Cochran-Mantel-Haenszel test (Supplementary Table 2). Interestingly, when adjusting for sex, the association between psoriasis and benign parathyroid neoplasms in subjects aged 45–64 years is no longer significant (sex-adjusted odds ratio = 1.726, 95% CI = 0.554–5.377, p = 0.346). The association between psoriasis and benign pituitary and craniopharyngeal neoplasms in subjects aged 65 years or greater also disappears when adjusting for sex (sex-adjusted odds ratio = 1.546, 95% CI = 0.876–2.730, p = 0.133). This observation is concordant with the previous finding that the incidence of pituitary tumors peaks between the ages of 60–70, and the prevalence of this condition is much higher in males compared with females.²¹

Figure 3.

Prevalence rates of benign endocrine neoplasms in each cohort. The prevalence rates of benign neoplasms originating from specific endocrine glands are shown, with black bars representing the control cohort and gray bars representing the psoriasis cohort. The pituitary category also encompasses neoplasms of the craniopharyngeal duct or pouch.

Figure 4.

Age-adjusted odds ratios showing the association between psoriasis and benign neoplasms of specific endocrine glands. The blue dot represents the odds ratio and the error bars represent the 95% confidence interval. The pituitary category also encompasses neoplasms of the craniopharyngeal duct or pouch.

Discussion

Overall, this study found significantly higher rates of endocrine disorders such as adrenal insufficiency, Cushing’s syndrome, hypothyroidism, hyperthyroidism, primary hyperparathyroidism, T1DM, T2DM, and PCOS in patients with psoriasis who were receiving care at a tertiary medical center. These results suggest a higher likelihood of endocrine dysfunction in this population. However, the generalizability of results from this study may be limited. The prevalence of psoriasis in this database was only 0.32%, far less than the prevalence of this condition in the United States (around 3%).² This may be explained in part by the acute nature of many of these tertiary care visits, potentially failing to capture a chronic diagnosis such as psoriasis. There is also inherent loss of patient disease or comorbidity characterization when relying on retrospective PheWAS coding extraction. Additionally, odds ratios for comorbid conditions in this study were higher than previously reported results. A likely explanation here is that once patients are diagnosed with psoriasis, the often more robust connection with the healthcare system, and the accompanying increased clinical surveillance and frequency of patient visits, may lead to higher rates of incidental diagnostic testing and billing code assignments for asymptomatic or mild endocrine conditions when contrasted with the general population. The role of medications used to treat psoriasis must also be considered as a confounding factor. For instance, the use of methotrexate may be associated with the development of hypothyroidism.²²

This study also found significant associations between psoriasis and benign neoplasms of specific endocrine glands, including the adrenal, thyroid, parathyroid, and pituitary glands. However, it is noted that for certain age groups, such as the 45–64 cohort in the analysis of benign parathyroid neoplasms and the 65+ cohort in the analysis of benign pituitary and craniopharyngeal neoplasms, sex may be a confounding factor. Additionally, extrapolation of this data to explain general hormone irregularities in patients with psoriasis may be limited. This study is also the first to report a significant association between psoriasis and Cushing’s syndrome. In 2015, a cohort study of 62 patients with Cushing’s syndrome was noted to have a psoriasis prevalence of 5%.²³ Additionally, hypothalamic-pituitary-adrenal (HPA) axis dysregulation has been previously investigated in patients with psoriasis: individuals with psoriasis were found to have significantly lower salivary cortisol levels compared with control patients, and the adrenocorticotropin/cortisol ratio in venous blood was found to be positively correlated with disease severity, overall suggesting an impaired HPA axis response to stress.^24,25 While this literature provides potential mechanistic insights into the association between psoriasis and adrenal insufficiency, increased levels of IL-6 and IL-1β in patients with Cushing’s disease may contribute to the development of psoriasis in these individuals and explain the association between these two disorders.^26,27 It is acknowledged that a 2016 case-control study of patients with primary adrenal insufficiency reported no significant association with psoriasis, suggesting that more robust investigation is needed to further elucidate this relationship.¹⁵

To the authors’ knowledge, this study is also the first to document an association between psoriasis and primary hyperparathyroidism, as well as psoriasis and T1DM. With regard to the former, patients with severe psoriasis have been found to have significantly higher levels of parathyroid hormone (PTH), which was also independently correlated with impaired global left ventricular longitudinal strain.²⁸ A meta-analysis also demonstrated significantly increased PTH levels in patients with psoriasis, but this phenomenon may be attributed to the significantly lower levels of calcidiol, the main storage form of Vitamin D, in this population.²⁹ With regards to the latter, the prevalence of psoriasis in patients with T1DM has been found to be greater than the general population.^30,31 Combined with these studies, our results suggest that there may be a link between psoriasis and these endocrine disorders.

Consistent with other studies, we found a significant association between psoriasis and thyroid dysfunction, including specific thyroid autoimmune disorders.¹³ Elevated risk of chronic lymphocytic thyroiditis (adjusted hazard ratio = 1.47, 95% CI = 1.18–1.82) as well as Graves’ disease (adjusted hazard ratio = 1.26, 95% CI = 1.13–1.41) has been reported in psoriasis patients.³² However, in this study, not only did this association diminish when controlling for either hypothyroidism or hyperthyroidism respectively, but it was maintained when these autoimmune conditions were excluded. Combined with the strong association of psoriasis with other endocrine disorders as well as the signification association of this condition with benign endocrine neoplasms, this analysis suggests that the link between psoriasis and thyroid dysfunction may be more related to overall endocrine dysfunction rather than inflammatory damage to endocrine glands. However, it is acknowledged that no significant association was found between psoriasis and simple nontoxic goiter (adjusted hazard ratio =1.05, 95% CI = 0.99–1.12, p = 0.07) or toxic nodular goiter (adjusted hazard ratio = 0.89, 95% CI = 0.63–1.26, p = 0.59). These findings suggest that more investigation is needed into the mechanisms behind the increased likelihood of thyroid dysfunction in patients with psoriasis.

Study Limitations

As previously mentioned, PheWAS codes may not be accurately affixed to patient records, and thus raw numbers of patients with a certain condition that are extracted from the SD are estimates. When analyzing the number of patients with at least one endocrine abnormality (either adrenal insufficiency, Cushing’s syndrome, hypothyroidism, hyperthyroidism, primary hyperparathyroidism, T1DM, T2DM, and PCOS), secondary hyperparathyroidism could not be excluded, which may have overestimated the prevalence of individuals with at least one of these conditions. Data was analyzed in aggregate, and thus odds ratios were only adjusted for age and sex, and were not able to account for other possible confounders such as BMI, medications, chronic conditions, etc. For instance, it must be acknowledged that the higher prevalence of endocrine disorders such as Cushing’s syndrome and adrenal insufficiency in patients with psoriasis may be attributed to some degree to iatrogenic, rather than primary, causes as this population may be more likely to be prescribed systemic steroids. Finally, this is a single-center institution study, which limits the generalizability of findings.

Conclusion

In summary, this cross-sectional study noted a significant association between psoriasis and certain endocrine disorders in patients of a tertiary medical center. More robust inquiry is required to establish a relationship. However, based on current literature, endocrine dysfunction in patients with psoriasis may be a prevalent issue which requires a lower threshold for screening and treatment.

Funding Statement

This publication was supported by CTSA award No. UL1 TR002243 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

Data Sharing Statement

The Synthetic Derivative of the Vanderbilt Institute of Clinical and Translational Research is not a publicly available database, and therefore the raw data used in this study cannot be provided.

Ethics Approval

IRB exemption #251050 was approved by Vanderbilt University Medical Center Institutional Review Board on 07/18/25 to conduct this study. As data was taken from the Synthetic Derivative, a de-identified database that contains no protected health information, informed consent was not necessary.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The author(s) report no conflicts of interest in this work.

The abstract of this paper was presented at the 2026 Society for Investigative Dermatology Annual Meeting as a poster presentation/conference talk with interim findings. The poster’s abstract was published in “Society for Investigative Dermatology (SID) 2026 Meeting Abstract Supplement” in Journal of Investigative Dermatology: https://doi.org/10.1016/j.jid.2026.06.231.