A Juvenile Case of Cushing's Disease Incidentally Discovered with Multiple Bone Fractures

Yoshihara, Ai; Okubo, Yumiko; Tanabe, Akiyo; Sata, Akira; Nishimaki, Momoko; Kawamata, Takakazu; Kubo, Osami; Hori, Tomokatsu; Takano, Kazue

doi:10.2169/internalmedicine.46.1824

Cited by 11 publications

(8 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Osteoporosis, bone fragility and fractures are well-known complications of Cushing's syndrome (124,125,126,127,128). Data obtained from studies with exogenous corticoids have shown that the prevalence of fractures is correlated with their dosage.…”

Section: (G) Bone Fracturesmentioning

confidence: 99%

“…Fractures can affect the entire skeleton, with a high risk of vertebral fractures that will result in pain and the patient being bedridden (118,119,120,121). Aseptic necrosis of the femoral head is a painful complication that reduces mobility (127) and again confines the patient to bed. These fractures can affect even a very young patient (127).…”

Section: (G) Bone Fracturesmentioning

confidence: 99%

See 1 more Smart Citation

MANAGEMENT OF ENDOCRINE DISEASE: Cushing’s syndrome due to ectopic ACTH secretion: an expert operational opinion

Young

Haissaguerre

Viera-Pinto

et al. 2020

European Journal of Endocrinology

158

186

View full text Add to dashboard Cite

Ectopic ACTH syndrome (EAS) is rare but is frequently a severe condition because of the intensity of the hypercortisolism that may be dissociated from the tumoral condition. EAS should often be considered as an endocrine emergency requiring an emergency response both in terms of diagnostic procedures and therapeutic interventions. Patient management is complex and necessitates dual skills, in the diagnosis and treatment of CS and in the specific management of neuroendocrine tumors (NET). Therefore, initial management should be performed ideally by experienced endocrinology teams in collaboration with specialized hormonal laboratory, modern imaging platforms and intensive care units. Diagnostic procedures vary according to the endocrine and tumoral contexts but should be reduced to a minimum in intense hypercortisolism. Preventive and curative treatments of cortisol-induced comorbidities, non-specific management of hypercortisolism and etiological treatments should be considered simultaneously. Therapeutic strategies vary according to (1.) the intensity of hypercortisolism, the general condition of the patient and associated comorbidities and (2.) the tumoral status, ranging from resectable ACTH secreting tumors to non-resectable metastatic endocrine tumors or occult tumors. The ideal treatment is complete excision of the ACTH-secreting tumor that can be performed rapidly or after preoperative preparation using cortisol-lowering drugs. When this is not possible, the therapeutic strategy should be discussed by a multidisciplinary experienced team in a personalized perspective and include variable combinations of pharmacological agents, bilateral adrenalectomy and non-specific tumoral interventions. Here we discuss the diagnosis and therapeutic strategies including the modern, currently available tools and emphasize on the operational effectiveness of care.

show abstract

Section: (G) Bone Fracturesmentioning

confidence: 99%

Section: (G) Bone Fracturesmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Cushing’s syndrome due to ectopic ACTH secretion: an expert operational opinion

Young

Haissaguerre

Viera-Pinto

et al. 2020

European Journal of Endocrinology

158

186

View full text Add to dashboard Cite

show abstract

“…The prevalence of osteoporosis (defined as a dual energy absortiometry (DXA) T-score \-2.5) is very high among patients with CS being present in 55% of women with CS [40]. Fractures were reported in 19-50% of CS patients [40,41] with an overrepresentation of fractures of vertebrae and ribs [42,43].…”

Section: Effects Of Excess Pituitary-adrenal Axis Activity On Bonementioning

confidence: 99%

The pituitary–adrenal axis and body composition

2008

View full text Add to dashboard Cite

The activity of the pituitary-adrenal axis can profoundly impact on body composition. This is dramatically seen in Cushing's syndrome (CS) but changes in body composition are also implicated in depression and alcoholic pseudocushing's. The pathophysiological mechanisms underlying these changes remain poorly understood. Changes to body composition in CS include increased fat mass, decreased bone mass, thinning of the skin and reduced lean mass. Why these tissues are affected so dramatically is unclear. Additionally, the change in body composition between individuals varies considerably for reasons which are only now becoming evident. This paper reviews the phenotypic changes with altered pituitary-adrenal axis activity and discusses the mechanisms involved. The primary focus is on adipose, bone, muscle and skin since the most dramatic changes are seen in these tissues.

show abstract

“…The most common cause of Cushing's syndrome during pregnancy is adrenal adenoma; however, there have been cases published in which the cause is hypophysary adenoma 2 . In addition, Cushing's syndrome during pregnancy carries a higher level of maternal morbidity, in up to 70% of cases 3 , the most common complications being arterial hypertension and diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Fracturas vertebrales como debut de síndrome de Cushing diagnosticado tras un embarazo

Medina

Izquierdo

Curiel

2013

Rev Osteoporos Metab Miner

View full text Add to dashboard Cite

SummaryThe case is described of a 34 year old patient with Cushing's disease diagnosed as a result of having multiple pathological vertebral fractures after giving birth. The sudden appearance of acute fractures in five vertebral bodies, the phenotype characteristics of the patient and her medical history pointed to a diagnosis of Cushing's syndrome, a condition which rarely coincides with pregnancy. After a resection of the hypophysary adenoma and the start of treatment with teriparatide, the patient experienced notable clinical and densitometric improvement. This case demonstrates the importance of suspecting a bone metabolism disorder in the presence of pathological fractures in young patients, even more in certain states, such as pregnancy or lactation.

show abstract

A Juvenile Case of Cushing's Disease Incidentally Discovered with Multiple Bone Fractures

Abstract: A 19-year-old

Cited by 11 publications

References 17 publications

MANAGEMENT OF ENDOCRINE DISEASE: Cushing’s syndrome due to ectopic ACTH secretion: an expert operational opinion

MANAGEMENT OF ENDOCRINE DISEASE: Cushing’s syndrome due to ectopic ACTH secretion: an expert operational opinion

The pituitary–adrenal axis and body composition

Fracturas vertebrales como debut de síndrome de Cushing diagnosticado tras un embarazo

Contact Info

Product

Resources

About