Koch C A, Tsigos C, Patronas N J, Papanicolaou D A
Developmental Endocrinology Branch, National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1862, USA.
J Clin Endocrinol Metab. 1999 Sep;84(9):3010-2. doi: 10.1210/jcem.84.9.5992.
Nontraumatic avascular necrosis (AVN) of the hip is commonly caused by exogenous glucocorticoid administration, whereas it has rarely been associated with endogenous hypercortisolism. We report a 30-yr-old woman with Cushing's disease whose presenting manifestation was early AVN of the hip. Although plain x-ray was negative, magnetic resonance imaging (MRI) of the hip showed stage 2 AVN. Her orthopedic disease was considered an emergency, and thus, it was treated with core decompression before the diagnosis of Cushing's syndrome (CS) was pursued further. The femur recovered fully, as demonstrated by her improved clinical picture and a subsequent MRI. AVN carries a poor prognosis, if not treated early. The diagnostic procedure of choice is MRI, because plain radiographs are falsely negative in early stages. This case illustrates that AVN can be the presenting manifestation of CS; to prevent irreversible effects on the femoral head, core decompression should not be delayed for the purpose of evaluation and treatment of CS.
非创伤性股骨头缺血性坏死（AVN）通常由外源性糖皮质激素的使用引起，而与内源性皮质醇增多症的关联则很少见。我们报告了一名30岁患有库欣病的女性，其首发表现为早期股骨头缺血性坏死。尽管X线平片结果为阴性，但髋关节磁共振成像（MRI）显示为2期股骨头缺血性坏死。她的骨科疾病被视为急症，因此在进一步追查库欣综合征（CS）的诊断之前，先进行了髓芯减压治疗。从她改善的临床表现以及随后的MRI来看，股骨已完全恢复。股骨头缺血性坏死若不及早治疗，预后较差。首选的诊断方法是MRI，因为在疾病早期X线平片常呈假阴性。该病例表明，股骨头缺血性坏死可能是库欣综合征的首发表现；为防止对股骨头产生不可逆的影响，不应为了评估和治疗库欣综合征而延迟髓芯减压治疗。
