Endocrine Abstracts

Cushing’s syndrome can lead to various complications, including pathological fracture. As an initial presenting symptom pathological fracture is not very common in Cushing’s syndrome. This abstract aims to present a case study of a female patient with multiple pathological fractures at a young age and subsequently diagnosed with Cushing’s syndrome. A 32-year-old female (at the time of referral) after a stress fracture of the right neck of the femur without any trauma history, was treated with DHS(dynamic hip screw) and then referred to the Rheumatology clinic for investigation of secondary causes of fracture. She had normal childhood and puberty with uncomplicated pregnancy four years ago. Her past medical history and medication history were unremarkable. Her clinic blood pressure was high and antihypertensives were initiated. The next year she suffered from another unprovoked right superior pubic rami fracture and that triggered hormone profile investigation with an endocrine referral. Vitamin D level was mildly low and supplemented aggressively. She also had menstruation irregularity and subsequent cessation. The overnight dexamethasone suppression test failed to suppress. MRI pituitary was normal but adrenal MRI showed lipid-poor Right adrenal 3.3cm nodule suggestive of adenoma. DEXA scan showed osteopenia, ACTH was undetectable, high dose dexamethasone test failed to suppress as well,24 hrs urine cortisol came high compatible with adrenal Cushing’s. MDT discussion decided on adrenal surgery with initiation of Metyrapone and prophylactic VTE prophylaxis. After this management, she was doing well and started on corticosteroid which was weaned off subsequently when pituitary-adrenal axis partially improved. She is due for genetic testing as her parental aunt was found to be Cushing’s as well. This case highlights the importance of recognizing and addressing the skeletal consequences of Cushing’s syndrome. Collaborative efforts among endocrinologists, orthopedic surgeons, and other healthcare professionals are vital in managing these complex cases effectively.