Lee Hyun Jung, Je Ji Hye, Seo Ji Hye, Na Young Ju, Yoo Hye Jin
Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.
J Bone Metab. 2014 Nov;21(4):277-82. doi: 10.11005/jbm.2014.21.4.277. Epub 2014 Nov 30.
Glucocorticoid (GC) excess, including Cushing's syndrome, is a common cause of secondary osteoporosis. Thirty to fifty percent of Cushing's syndrome patients experience non-traumatic fractures, which is often the presenting manifestation of Cushing's syndrome. However, there have been rare cases of Cushing's syndrome diagnosed only based upon bone manifestations. We describe a case of Cushing's syndrome that was diagnosed in a 44-year-old woman who initially visited our hospital due to multiple non-traumatic rib fractures. She did not exhibit any other manifestations of Cushing's syndrome such as moon face, buffalo hump or abdominal striae. Initially, we evaluated her for bone metastases from a cancer of unknown origin, but there was no evidence of metastatic cancer. Instead, we found a left adrenal incidentaloma. As a result of the hormone study, she was diagnosed as having Cushing's syndrome. Interestingly, her bony manifestation of Cushing's syndrome, which was evident in the bone scan and bone mineral densitometry, completely recovered after a left adrenalectomy. Therefore, the possibility of Cushing's syndrome as a cause of secondary osteoporosis should be considered in young patients with non-traumatic multiple fractures, with or without any other typical features of Cushing's syndrome.
糖皮质激素（GC）过多，包括库欣综合征，是继发性骨质疏松症的常见原因。30%至50%的库欣综合征患者会发生非创伤性骨折，这往往是库欣综合征的首发表现。然而，仅有少数病例仅根据骨骼表现确诊为库欣综合征。我们描述了一例库欣综合征病例，该病例为一名44岁女性，最初因多处非创伤性肋骨骨折前来我院就诊。她没有表现出库欣综合征的任何其他表现，如满月脸、水牛背或腹部条纹。最初，我们对她进行了不明来源癌症骨转移的评估，但没有转移性癌症的证据。相反，我们发现了左侧肾上腺意外瘤。通过激素检查，她被诊断为库欣综合征。有趣的是，她在骨扫描和骨密度测量中明显的库欣综合征骨骼表现，在左侧肾上腺切除术后完全恢复。因此，对于有或没有库欣综合征任何其他典型特征的非创伤性多发骨折的年轻患者，应考虑库欣综合征作为继发性骨质疏松症病因的可能性。
