Department of General Surgery, All India Institute of Medical Sciences, Patna, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, India.
Am Surg. 2023 Jun;89(6):2701-2704. doi: 10.1177/00031348221129510. Epub 2022 Sep 22.
A wide range of clinical presentations for Cushing's syndrome has been described in the literature. Avascular necrosis of femur is a well-recognized complication of excessive glucocorticoid administration, but its occurrence due to endogenous hypercortisolism is rare. We present the case of a 47-year-old male who presented to us with severe low backache, hypertension, uncontrolled diabetes, and other signs and symptoms of Cushing's syndrome. Hormonal evaluation confirmed hypercortisolism, and a contrast-enhanced computed tomography of the abdomen localized the lesion in the left adrenal gland. Assessment of the severe low back ache-the main symptom for which the patient came to us-by magnetic resonance imaging of the spine and pelvis revealed avascular necrosis of bilateral femoral heads. Resection of the left adrenal gland revealed an adrenocortical carcinoma. To the best of our knowledge, this is only the second case where an adrenocortical cancer leading to hypercortisolism is the cause of avascular necrosis of hip.
库欣综合征的临床表现多种多样，文献中有相关描述。股骨无菌性坏死是糖皮质激素过量应用的一种公认并发症，但由内源性皮质醇增多症引起者较为罕见。我们报告 1 例 47 岁男性患者，因严重腰痛、高血压、糖尿病控制不佳等库欣综合征的其他症状和体征就诊。激素评估证实皮质醇增多，腹部增强 CT 定位病变在左侧肾上腺。对脊柱和骨盆磁共振成像评估严重腰痛（患者就诊的主要症状）显示双侧股骨头无菌性坏死。左侧肾上腺切除显示为肾上腺皮质癌。据我们所知，这仅是皮质醇增多症由肾上腺皮质癌引起导致髋部无菌性坏死的第二例病例。
