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Type 2 diabetes with recurrent osteoporotic fractures, or Cushings syndrome?
Medrech
ABSTRACT:
Aim: Presentation of a case with secondary osteoporosis and compressive fracture in Cushings
syndrome.
Clinical Case: A 41 years old male was admitted to our hospital with inability to move the legs,
severe back pain, which started 6 months ago. The patient was bedridden for a month due to
severe pain. He was under treatment for hepatitis B and had been for more than three years under
treatment for diabetes. One year ago he was treated for deep venous thrombosis.
Laboratory data: Loss of circadian rhythm of cortisol, increased free urinary cortisol level, lack
of suppression of cortisol after 1 mg dexamethasone test. DXA: Osteoporosis. Spine x-Ray:
recurrent osteoporotic compressive thoracic fracture. Abdominal MRI showed left adrenal
nodular mass with dimensions 2.5 x 3.3 cm. The patient underwent surgery: Left adrenalectomy.
12 months after surgery the patient continuing the treatment with hydrocortisone, alendronate,
calcium and vitamin D, normal values of blood glucose and blood pressure without treatment
and in DXA an improvement of the bone density was noticed.
Keywords: Cushings syndrome; secondary osteoporosis; osteoporotic compressive fracture
from excessive levels of systemic
Introduction:
Cushings disease was first described in
glucocorticoids (2). Cushings syndrome is
associated with increased risks of
1932 from the American neurosurgeon
Harvey Cushing (1). The incidence of
cardiovascular, metabolic, and respiratory
Cushings syndrome is not exact, because of
disorders,
psychiatric
complication,
the undiagnosed cases with slight
osteoporosis and infection, which all lead to
hypercortisolemia and the lack of data about
increased rates of morbidity and mortality
iatrogenic Cushing (1). Cushings syndrome
(2). The classic features of Cushings
is a serious condition associated with high
syndrome include central obesity, moon
face, and hirsutism (3). Cushings syndrome
rates of morbidity and mortality that result
Dyrmishi B. et al., Med. Res. Chron., 2015, 3 (1), 110-114
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Laboratory data:
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The laboratory examinations showed a loss of the circadian rhythm of cortisol, increased level of
free urinary cortisol. A one mg over night dexamethasone suppression test was performed; the
plasma cortisol was not suppressed and abdominal magnetic resonance imaging (MRI) was
requested, it showed left adrenal nodular mass with dimensions 2.5 x 3.3 cm.
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