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ID 116832
Title Alternative
A case of Cushing’s syndrome detected by repeated fragility fractures
Author
Kimura, Ranko Tokushima University
Hosoki, Minae Tokushima University
Tsuji, Seijiro Tokushima University
Mitsui, Yukari Tokushima University
Akehi, Yuko Tokushima University
Keywords
Cushing syndrome
fragility fracture
Premenopausal woman
Content Type
Journal Article
Description
A 38-year-old woman had suffered from an avulsion fracture of the left cuboid bone, a rib fracture, a fatigue fracture of the left second metatarsal bone and a pubic fracture within the last 4 years. She also realized that her face was getting rounded and became aware of edema on extremities. She had repeated fragile fractures before menopause and was referred to our department on suspicion of secondary osteoporosis. The patients showed physical signs of moon face, central obesity, and abdominal violaceous striae. Cushing’s syndrome was suspected, therefore confirmatory studies were performed. Circadian variation of cortisol : serum cortisol19.3μg/dL(at7:00), 21.4μg/dL(at23:00), urinary free cortisol :247.4μg/24h, ACTH :2.5pg/mL. Low-dose(1mg) dexamethasone did not suppress cortisol level(18.9μg/dL). Based on these findings, we diagnosed as Cushing’s syndrome and glucocorticoid excess seemed to be the cause of secondary osteoporosis. Abdominal CT identified a 2.7 cm tumor in the left adrenal gland, and in-phase T1‐weighted MRI showed decreased signal compared to out-phase, suggesting an adrenocortical adenoma. She underwent laparoscopic left adrenalectomy. Postoperative fasting serum cortisol decreased to2.2 μg/dL, and glucocorticoid replacement therapy was started. It is necessary to find out any secondary causes for premenopausal women with fragility fractures. It is well known that endocrine disorders including Cushing’s syndrome are the most frequent associated diseases in patients with premenopausal osteoporosis. Cushing’s syndrome should be considered as a causative disease in premenopausal women with osteoporosis.
Journal Title
Shikoku Acta Medica
ISSN
00373699
NCID
AN00102041
Publisher
徳島医学会
Volume
77
Issue
5-6
Start Page
269
End Page
274
Sort Key
269
Published Date
2021-12-25
EDB ID
FullText File
language
jpn
TextVersion
Publisher
departments
University Hospital
Medical Sciences
Institute of Advanced Medical Sciences