Endocrine Abstracts

Cushing’s induced osteoporosis: a case of back pain with a limp

CM Gibson

Manchester Royal Infirmary, Manchester, United Kingdom.

Osteoporosis is defined as a skeletal disorder characterised by reduced bone mineral density, predisposing a person to an increased risk of fracture. An estimated 3 million people in the UK suffer from the condition, most of these are women. Early intervention is important because bone loss is progressive and so is the risk of fracture.

A 28 year old lady presented to a local hospital complaining of pain in her right hip which caused her to limp. She was noted to be floridly Cushingoid and referred to the endocrinologists. X-rays demonstrated an impacted fracture of the right hip and bilateral stress fractures of the pubic rami. X-rays of the lumbar spine were suggestive of osteoporosis.

Her Cushing’s disease was treated initially with pituitary hypophysectomy. She had a successful operation on her hip and was given a bisphosphonate for the osteoporosis.

A subsequent recurrence of her Cushing’s disease required bilateral adrenalectomy. The patient’s latest bone densitometry scan demonstrates persisting osteopaenia, and she has had vertebral crush fractures of T9/10. A rib fracture occurred during a chest infection.

Exposure to excess glucocorticoid poses a recognised risk to the skeleton. Osteoporosis treatment in this lady was complicated by the recurrent nature of her Cushing’s disease and her young age at presentation.

Endocrine Abstracts (2005) 10 S29