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The
th Annual Meeting of March 19-20, 2016 The Endocrine Society and The Diabetes Association of the R.O.C. (Taiwan)
PP-01
A YOUNG ADULT WOMAN WITH SEVERE OSTEOPOROSIS DUE TO CUSHING’S DISEASE YAN-RONG LI, CHIH-YIU TSAI, CHENG-WEI LIN, SZU-TAH CHEN, JEN-DER LIN, JAWL-SHAN HWANG Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan, R.O.C.
Background: Glucocorticoid-induced osteoporosis (GIOP) can result in loss of bone mass and eventually cause fractures of the ribs, long bones and spinal vertebra. Most people of GIOP is because of side effects of iatrogenic glucocorticoid use but not endogeneous glucocorticoid. Severe osteoporosis due to endogenous hypercortisonism was relatively uncommon in the clinical setting, especially for a young adult woman. Therefore, we present a case of a 35-year-old premenopausal woman with severe osteoporosis due to Cushing’s disease who presented with multiple low trauma fractures. Case presentation: A 35-year-old was admitted to our orthopedic department because of left pubic bone fracture after falling from a standing height on a rainy day. She was a well-nourished, normal development, non-pregnant and premenopausal woman who never delivered a child. She ever got multiple rib fractures after slipping on the road one year before admission. She had regular menstrual cycles and denied smoking, alcohol consumption, taking any medication and drug containing ingredients of steroid or Chinese herb. According to her family history, her grandmother had oral cancer and two aunts had breast cancer. Physical exam showed no obvious finding except for overweight based on criteria in Taiwan (body mass index: 26.5 Kg/m2). She was referred to our oncologist’s and endocriologist’s service to rule out pathological fractures. Laboratory results showed 24-hour urine free cortisol (24-h UFC) was 1298.7 ug/day (normal range: 20.9 ~ 292.3 ug/day) with serum adrenocorticotropic hormone (ACTH) 68.4 pg/mL and positive high dose dexamethasone suppression test. Pituitary magnetic resonance imaging (MRI) revealed pituitary microadenoma (7x5x5 mm) in the left-sided pituitary gland. Transsphenoidal surgery for tumor resection was performed and the pathological result showed pituitary tissue with positive immunohistochemical study for ACTH. Severe osteoporosis due to Cushing’s disease was diagnosed definitely. Conclusion: A young adult woman with severe osteoporosis due to Cushing’s disease was a relatively uncommon in our clinical practice. We hope that our experience of this case will remind physicians to be aware of this unusual complication of Cushing’s disease.
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