Multiple Metatarsal Fractures: The First Manifestation of Cushing's Disease—A Case Report

Molnar, Vilim; Zekan, Paulo; Dušek, Tina; Ivković, Alan

doi:10.7547/19-024

Cited by 3 publications

(8 citation statements)

References 4 publications

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“…Pathology confirmed a pituitary adenoma. The association of multiple, non-traumatic metatarsal fractures occurring in premenopausal women with endogenous CS has been reported in the literature [ 3 , 7 , 19 ]. However, to the best of our knowledge, this is the first report presenting a premenopausal woman with multiple, recurrent metatarsal fractures as the initial manifestation of CD.…”

Section: Discussionmentioning

confidence: 99%

“…Several mechanisms play a role in glucocorticoid-induced bone loss, which is more prominent in trabecular bone compared to cortical bone [ 3 , 4 , 6 , 8 ]. Normally, trabecular bone has a greater bone turnover rate than cortical bone.…”

Section: Discussionmentioning

confidence: 99%

“…When evaluating a patient with this presentation, secondary causes for these fractures need to be investigated. Differential diagnoses include osteoporosis, Charcot foot, multiple myeloma, celiac disease, avascular necrosis, and endocrine disorders such as hyperthyroidism, primary hyperparathyroidism, or CS, among others [ 3 , 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, CS more commonly affects women [ 2 ]. Common characteristics of CS include truncal obesity, moon facies, proximal muscle weakness, fatigue, facial plethora, supraclavicular fullness, peripheral edema, weight gain, striae, easy bruising, acne, hirsutism, amenorrhea, dorsocervical "buffalo" hump, depression, hypertension, impaired glucose tolerance, and osteoporosis [ 1 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…The most commonly reported fracture site in CS patients is the vertebrae; however, other reported fracture sites include the ribs, sternum, wrist, elbow, shoulder, pelvis, hip, femoral condyles, tibia, fibula, calcaneus, metatarsals, and phalanges [ 4 , 6 - 16 ]. There are reports of metatarsal fractures occurring in patients diagnosed with endogenous CS [ 3 , 6 , 7 , 16 - 19 ]. However, to the best of our knowledge, there are no reports of multiple, recurrent, bilateral metatarsal fractures as the initial presentation in a pre-menopausal woman with CD.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Recurrent Metatarsal Fractures in a Patient With Cushing Disease: A Case Report

Iturregui¹,

Shi²

2022

Cureus

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Cushing syndrome (CS) can result from excess exposure to exogenous or endogenous glucocorticoids. The most common endogenous cause of CS is an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma, known as Cushing disease (CD). Patients typically present with characteristics including truncal obesity, moon facies, facial plethora, proximal muscle weakness, easy bruising, and striae. Insufficiency fractures of the metatarsals are a rare presentation for CS. A 39-year-old premenopausal woman presented to the orthopedic outpatient clinic with recurrent metatarsal fractures and no history of trauma. A metabolic bone disease was suspected, and after further evaluation by endocrinology services, the CD was diagnosed. Surgical resection was performed, and pathology confirmed the presence of a pituitary adenoma. Multiple, recurrent, non-traumatic metatarsal fractures can be the initial presentation of CD in a premenopausal woman.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Recurrent Metatarsal Fractures in a Patient With Cushing Disease: A Case Report

Iturregui¹,

Shi²

2022

Cureus

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Recurrent femoral neck fractures: keep an eye out for Cushing’s syndrome

Alam,

Patra,

Agrawal

et al. 2024

BMJ Case Rep

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Prolonged glucocorticoid overexposure leads to Cushing’s syndrome (CS). It is characterised by diverse metabolic, cardiovascular and bone mineral manifestations. A middle-aged woman presented for a preoperative evaluation of a pathological fracture of the left neck of the femur. She had a history of a hip fracture on the opposite side 3 years back. She exhibited several features specific to CS and was subsequently diagnosed with Cushing’s disease. She underwent transsphenoidal adenoma resection and achieved remission. Glucocorticoids primarily affect the trabecular bone compared with cortical bones, and vertebral fractures are common in CS. The femoral neck consists of both trabecular and cortical bone and can be involved in CS. Our patient was not diagnosed as CS at the first pathological fracture and was subsequently diagnosed only after the second fracture. This case report underscores the importance of a diligent search for a possible endocrinological aetiology in any case of pathological fractures.

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Proximal muscle weakness as the sole manifestation of Cushing’s disease, misdiagnosed as dermatomyositis: a case report

Jeddi

Shams

2022

J Med Case Reports

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Background Cushing’s syndrome consists of signs and symptoms related to prolonged exposure to high levels of glucocorticoid, and should be considered in individuals with the discriminatory signs and symptoms. Proximal myopathy is an important discriminatory sign. Case presentation We report the case of a 36-year-old Iranian man who presented with proximal muscle weakness. He visited a rheumatologist in an outpatient clinic, and according to proximal muscle weakness and heliotrope rash (based on the rheumatologist’s notes) with the impression of dermatomyositis, prednisolone and azathioprine were prescribed for him that did not improve his clinical status and he was gradually wheelchair dependent. He was admitted to the hospital for evaluation of paraneoplastic syndromes. Standard laboratory tests and imaging were unremarkable, other than a brain magnetic resonance imaging that demonstrated a 30 × 12 mm homogeneously enhancing mass in the sellar region with extension to the suprasellar area. He had serum cortisol of 295 ng/mL, and adrenocorticotropic hormone of 222 pg/mL (on 5 mg prednisolone twice daily), with a diagnosis of Cushing’s disease. He underwent two sessions of trans-sphenoidal surgery 4 months apart. After the first surgery, the proximal muscle weakness improved dramatically and he was walking with the aid of a walker, and after the second surgery he is walking without any aids. Conclusion This case report emphasizes the high diagnostic importance of proximal muscle weakness as the sole presenting manifestation of Cushing’s syndrome/disease.

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Multiple Metatarsal Fractures: The First Manifestation of Cushing's Disease—A Case Report

Cited by 3 publications

References 4 publications

Recurrent Metatarsal Fractures in a Patient With Cushing Disease: A Case Report

Recurrent Metatarsal Fractures in a Patient With Cushing Disease: A Case Report

Recurrent femoral neck fractures: keep an eye out for Cushing’s syndrome

Proximal muscle weakness as the sole manifestation of Cushing’s disease, misdiagnosed as dermatomyositis: a case report

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