Höch Andreas, Pieroh Philipp, Dehghani Faramarz, Josten Christoph, Böhme Jörg
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany; Department of Anatomy and Cell Biology, Martin Luther University of Halle-Wittenberg, Grosse Steinstrasse 52, 06097 Halle (Saale), Germany.
Case Rep Orthop. 2016;2016:9250938. doi: 10.1155/2016/9250938. Epub 2016 Jan 20.
Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle. We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilization. Prior to the injury, she received high-dose glucocorticoids for a tentative diagnosis of rheumatoid arthritis over two months. This diagnosis was not confirmed. Other causes leading to the unstable pelvic girdle were excluded by several laboratory and radiological examinations. Elevated basal cortisol and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormone-dependent Cushing's disease. The combination of adrenocorticotropic hormone-dependent Cushing's disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors' knowledge, this case presents the first description of a rotationally unstable pelvic ring fracture involving a predominantly ligamentous insufficiency in the context of combined exogenous and endogenous glucocorticoid elevation.
糖皮质激素因改变骨骼结构和增加骨折风险而广为人知。然而，与其他骨骼相比，关于骨盆环骨折的报道非常少，尤其是主要由韧带功能不全导致的旋转不稳定骨盆带骨折。我们报告一例39岁绝经前女性，患有非创伤性耻骨联合分离和左侧骶髂关节脱位。她表现为骨盆外旋不稳定并需要固定。受伤前，她因类风湿关节炎疑似诊断接受了两个月的高剂量糖皮质激素治疗。该诊断未得到证实。通过多项实验室和影像学检查排除了导致骨盆带不稳定的其他原因。测量了基础皮质醇和促肾上腺皮质激素水平升高，随后的促肾上腺皮质激素释放激素刺激试验、地塞米松抑制试验和岩下窦采血证实了促肾上腺皮质激素依赖性库欣病的诊断。促肾上腺皮质激素依赖性库欣病与额外应用外源性糖皮质激素相结合，是绝经前患者罕见的非创伤性旋转骨盆不稳定的最可能原因。据作者所知，该病例首次描述了在外源性和内源性糖皮质激素升高的情况下，主要由韧带功能不全导致的旋转不稳定骨盆环骨折。
