Lower extremity insufficiency fractures: an underappreciated manifestation of endogenous Cushing’s syndrome

• Published in: Osteoporosis international Vol. 27; no. 12; pp. 3645 - 3649
• Main Authors: Poonuru, S., Findling, J. W., Shaker, J. L.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-12-2016; Springer Nature B.V
• Subjects: Adrenocorticotropic hormone; Adult; Aged; Bone density; Case Report; Cortisol; Cushing syndrome; Cushing Syndrome - complications; Cushing Syndrome - diagnosis; Diagnosis; Endocrinology; Female; Fractures; Fractures, Stress - diagnosis; Fractures, Stress - etiology; Humans; Hydrocortisone; Lower Extremity; Medicine; Medicine & Public Health; Middle Aged; Nervous system diseases; Orthopedics; Osteoporosis; Pituitary; Retrospective Studies; Rheumatology; Steroids; Vertebrae; Dexamethasone Suppression Test; Inferior Petrosal Sinus Sampling; Vertebral Compression Fracture; Trabecular Bone Score; Insufficiency Fracture
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-016-3712-6

This report describes the presence of lower extremity insufficiency fractures in 10 women prior to the clinical and biochemical diagnosis of endogenous Cushing’s syndrome (CS). Osteoporosis is a well-recognized complication of overt CS resulting in a high rate of vertebral and other fractures. After institutional review board (IRB) approval, we did a retrospective chart review of patients with lower extremity (LE) insufficiency fractures (IF) and CS. This chart review found 10 women in whom LE-IF preceded the diagnosis of endogenous CS. Low bone density was found in all but one patient. The CS was considered to be mild (or subclinical) in five patients. LE-IF should be considered part of the skeletal spectrum of CS. Physicians caring for patients with LE-IF should have a low threshold for the consideration of CS even in patients without overt physical evidence of cortisol excess.