Lesson of the week: Spontaneous rupture of Achilles tendon: missed presentation of Cushing's syndrome

Mousa, Abdusalam; Jones, Steve; Toft, A. D.; Perros, Petros

doi:10.1136/bmj.319.7209.560

Cited by 16 publications

(11 citation statements)

References 15 publications

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“…9 These findings support the predisposition of spontaneous Achilles tendon rupture in patients diagnosed with Cushing syndrome. 3 However, our patient denies previous medical management with the drug class, and has no symptoms or lab abnormalities consistent with Cushing syndrome.…”

Section: Discussionmentioning

confidence: 70%

“…Ruptures of these tendons are frequent in patients with rheumatoid arthritis, systemic lupus erythematosus, Cushing syndrome, gout, hyperparathyroidism/ chronic renal failure, and seronegative spondyloarthropathies. 1-7 Obesity has also been cited as a predisposing factor to tendon ruptures. 8 Furthermore, tendon ruptures are well-known adverse effects of medications such as oral steroids, corticosteroid injections, and fluoroquinolones.…”

Section: Introductionmentioning

confidence: 99%

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Multiple Tendon Ruptures of Unknown Etiology

Axibal

Anderson

2013

Foot & Ankle Specialist

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Multiple Tendon Ruptures of Unknown Etiology

Axibal

Anderson

2013

Foot & Ankle Specialist

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“…-maladies infectieuses (tuberculose, syphilis) [14] ; -maladies métaboliques (goutte, maladie de Cushing) [15,16].…”

Section: Discussionunclassified

Spontaneous bilateral rupture of the Achilles tendon: a case report

et al. 2007

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Les auteurs rapportent une observation de rupture bilatérale du tendon d'Achille, chez un patient asthmatique sous corticothérapie au long cours. Ils évoquent les différentes étiologies incriminées. Ils discutent le rôle de la corticothérapie dans la genèse de cette rupture et pré-conisent une réparation chirurgicale des tendons. Mots clés : Tendon d'Achille -Rupture spontanée bilatérale -CorticothérapieAbstract: The authors report a case of spontaneous bilateral rupture of the Achilles tendon in a patient with asthma undergoing long-term steroid therapy. They review various aetiologies of the disorder and discuss the effect of steroid therapy on tendon rupture. They advocate surgical repair.

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“…Cushing's syndrome is a clinical condition resulting from chronic glucocorticoid excess (23). In addition to a multitude of clinical manifestations, sufferers of Cushing's syndrome are predisposed to Achilles tendon rupture (24). It is noteworthy that many of the clinical manifestations of Cushing's syndrome (15) overlap with the metabolic features that have been associated with tendinopathy (e.g.…”

Section: Cushing's Syndrome Patients Have Increased Tendon Rupture Riskmentioning

confidence: 99%

Does glucocorticoid exposure explain the association between metabolic dysfunction and tendinopathy?

Lewis

Zeisig

Gaida

2020

Endocrine Connections

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Background While metabolic health is acknowledged to affect connective tissue structure and function, the mechanisms are unclear. Glucocorticoids are present in almost every cell type throughout the body and control key physiological processes such as energy homeostasis, stress response, inflammatory and immune processes, and cardiovascular function. Glucocorticoid excess manifests as visceral adiposity, dyslipidemia, insulin resistance, and type 2 diabetes. As these metabolic states are also associated with tendinopathy and tendon rupture, it may be that glucocorticoids excess is the link between metabolic health and tendinopathy. Objective To synthesise current knowledge linking glucocorticoid exposure to tendon structure and function. Methods Narrative literature review. Results We provide an overview of endogenous glucocorticoid production, regulation, and signalling. Next we review the impact that oral glucocorticoid has on risk of tendon rupture and the effect that injected glucocorticoid has on resolution of symptoms. Then we highlight the clinical and mechanistic overlap between tendinopathy and glucocorticoid excess in the areas of visceral adiposity, dyslipidemia, insulin resistance and type 2 diabetes. In these areas, we highlight the role of glucocorticoids and how these hormones might underpin the connection between metabolic health and tendon dysfunction. Conclusions There are several plausible pathways through which glucocorticoids might mediate the connection between metabolic health and tendinopathy.

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Lesson of the week: Spontaneous rupture of Achilles tendon: missed presentation of Cushing's syndrome

Cited by 16 publications

References 15 publications

Multiple Tendon Ruptures of Unknown Etiology

Multiple Tendon Ruptures of Unknown Etiology

Spontaneous bilateral rupture of the Achilles tendon: a case report

Does glucocorticoid exposure explain the association between metabolic dysfunction and tendinopathy?

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