ECE2023 Eposter Presentations Adrenal and Cardiovascular Endocrinology (124 abstracts)
It hit two targets with one arrow. A case report of Cushing’s syndrome as a contributing cause for osteoporosis and thrombosis in a 64-year-old female
Marina Iliescu 1 , Marius Mitrache 1,2 , Raluca Stan 1 , Ana Zubaci 1 , Sabina Dumitrache 1 , Iustina Grosu 1 , Mihaela Tarna 1 , Alexandra Bancu 1 , Horatiu Dinu 3 , Sergiu Barsan 4 , Luminita Cima 1,2 & Simona Fica 1,2
1Elias Emergency University Hospital, Endocrinology, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 3Elias Emergency University Hospital, Physical Medicine and Rehabilitation, Bucharest, Romania; 4Elias Emergency University Hospital, Cardiology, Bucharest, Romania
Cushing’s syndrome, whether it is ACTH-dependent or ACTH-independent, causes many complications due to chronic exposure of tissues to a glucocorticoid excess. Some of these are arterial hypertension, obesity, osteoporosis, coagulopathies, impaired glucose tolerance and diabetes. We present a case of Cushing’s syndrome diagnosed in a 64-year-old female that was referred to the Endocrinology Department from the Physical Medicine and Rehabilitation Department due to multiple vertebral compression fractures and low T score in DXA scan in order to receive anti-osteoporotic treatment. Our patient was known with a history of arterial hypertension grade 3, dyslipidemia, chronic cigarette smoking, lumbar spinal stenosis managed via surgical intervention 3 months prior to our endocrine hospitalisation, left hip arthroplasty, uterine fibroid, intestinal occlusion, multinodular goiter. Physical examination showed an obese patient with central fat distribution, facial and thoracic telangiectasias, high blood pressure, and a systolic murmur. During the screening for endocrine causes of osteoporosis, hormonal tests revealed normal values, except an inadequate supression of 8 am cortisol level after 1 mg overnight of dexamethasone. Subsequent investigations revealed a supressed basal level of ACTH, modified circadian rhythm of cortisol secretion and inadequate supression of cortisol level after 2×2 mg of dexamethasone. Further examinations were made and CT scan showed a mass of 38/35/34 mm in the left adrenal gland with imagistic characteristics suggestive of adenoma. Same CT scan also revealed a pulmonary embolism and massive thrombosis of inferior vena cava. After completion of anticoagulant therapy and remission of thrombosis, left adrenal surgical excision was successfully performed. After this surgical intervention, the patient was initiated with anabolic therapy for severe osteoporosis using a parathyroid hormone analog. The particularity of this case was represented by the cumulative factors leading to both osteoporosis and a procoagulant state. Both postmenopausal status and glucocorticoid excess, as seen in Cushing’s syndrome, are contributing to low bone mineral density and osteoporosis. Also, low mobility after previous surgical intervention and hipercortisolism pilled up to coagulation disorders in our patient.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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