ECE2013 Poster Presentations Clinical case reports – Pituitary/Adrenal (57 abstracts)
Osteoporotic fractures as manifestation of Cushing’s disease
Cláudia Nogueira 1, , Selma Souto 1, , João Quinaz 1, , Daniel Braga 1, , Eduardo Vinha 1, , Elisabete Rios 1, , Irene Bernardes 1, , Josué Pereira 1, & Davide Carvalho 1,
1Centro Hospitalar São João, Porto, Portugal; 2Faculty of Medicine, University of Porto, Porto, Portugal.
Introduction: Cushing’s syndrome (CS) is a well-known cause of bone loss and osteoporotic fractures, which may be the initial manifestation of the disease and may present 2 years before CS diagnosis. Trabecular bone is usually the most seriously affected, and vertebrae and ribs are the typical fracture locations.
Case report: A 37-year-old man with dyslipidemia and obesity was observed due to uncontrolled hypertension and osteoporosis. He complained of back pain and loss of 6 cm height in the last year. Dorsal and lumbar spine X-ray performed before the appointment showed D12 vertebral body fracture and bone densitometry revealed osteoporosis. Physical examination revealed BMI 29.4 kg/m2, mild facial plethora, thin limbs and central obesity. The hormonal study showed urinary free cortisol 687.3 μg/24 h (36–137) and ACTH 118 ng/l (n<53). Thyroid function and 24-h urine catecholamines and metanephrines were normal. Serum cortisol after 1-mg overnight dexamethasone suppression test was 39.5 g/dl. Pituitary MRI revealed an image suggestive of an intraparenchymal pituitary cyst. A thorax CT scan showed old fractures of some ribs bilaterally, without pulmonary nodules. Bilateral inferior petrosal sinus sampling (BIPSS) revealed a central-peripheral gradient >3. He underwent transsphenoidal surgery, and histological examination confirmed an adenoma with diffuse immunostaining for ACTH and focal for GH. The first day postoperative cortisol level was 5.0 μg/dl. He was started on replacement therapy with hydrocortisone and was oriented to Orthopedics appointment for surgical treatment of vertebral fracture.
Discussion: The investigation of osteoporotic fractures and secondary causes of hypertension was essential for the diagnosis of CS, considering that clinical features of CS were scarce. Hypercortisolism etiology was established after ACTH determination and BIPSS, which allowed adequate therapeutic guidance. Several studies have demonstrated that resolution of hypercortisolism is associated with increased bone mass, although the recovery is often slow and incomplete.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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