Endocrine Abstracts

Introduction: Systemic lupus erythematosus is a systemic autoimmune disease, which often necessitates the administration of corticosteroids for its treatment. Cushing’s syndrome is a disorder characterized by the endogenous hypersecretion of cortisol.

Aim: The aim was to describe the case of a patient who had systemic lupus erythematosus, was on therapy with corticosteroids and developed Cushing’s syndrome.

Case description: A patient, female, aged 34, had systemic lupus erythematosus and was on therapy with corticosteroids. While on therapy with corticosteroids she developed depression, extreme fatigue, amenorrhea, face plethora and a buffalo’s hump. Subsequently, she presented with a spontaneous fracture of the pubic rami, which she suffered while walking. The fracture was managed conservatively. Thereafter, the patient suffered a fracture of the left 5th metatarsal bone. A year later, she suffered a spontaneous rib fracture. Bone densitometry revealed a T-score of −2.5 in the lumbar spine. Corticosteroids were discontinued. Further laboratory evaluation revealed urinary cortisol 235 μg/24 h (normal range 3.5–45 μg/24 h), morning cortisol 17.7 μg/dl and ACTH 1.2 pg/ml (normal range 7.2–64 pg/ml). An MRI of the abdomen revealed the presence of an adenoma measuring 3×2 cm in her left adrenal. The adenoma was surgically excised. A month later laboratory evaluation revealed low morning cortisol and hydrocortisone was administered. Menses recommenced and face plethora was no more evident. Systemic lupus erythematosus was managed by azathioprine. A year later bone densitometry revealed a T-score of −2.2 in the lumbar spine.

Conclusions: In conclusion, the case of a patient with systemic lupus erythematosus is presented who developed Cushing’s syndrome. Cushing’s syndrome was due to the presence of an adrenal adenoma. In the case presented Cushing’s syndrome manifested with amenorrhea, fatigue and spontaneous osteoporotic fractures in a very young patient. The diagnosis was masked by the therapeutic administration of corticosteroids. In a young patient spontaneous fractures should prompt a diagnostic evaluation for endocrine causes of osteoporosis.