Resumen
Spontaneous bone fractures: an infrequently reported complication of severe osteoporosis in Cushing??s disease
Fractura ósea espontánea: reporte de una complicación poco frecuente de osteoporosis severa en enfermedad de Cushing
VOLUMEN 3 - NÚMERO 3 / Julio - Septiembre (Imágenes en Endocrinología)
Claudia Ramírez-Rentería, Unidad de Investigación en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
Ernesto Sosa-Eroza, Grupo de Trabajo en Neuroendocrinología, Sociedad Mexicana de Nutrición y Endocrinología A.C., Ciudad de México; Servicio de Endocrinología, Unidad Médica de Alta Especialidad, Hospital de Especialidades Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México; México
A 69-year-old woman was diagnosed with an adrenocorticotropic hormone (ACTH)-producing pituitary microadenoma. She underwent transsphenoidal surgery in 2009, but her hypercortisolism had only a mild improvement. After refusing bilateral adrenalectomy and radiotherapy, she was started on oral ketoconazole 600 mg/day. A month later, her urinary free cortisol decreased to 54 µg/24 hours and there was a mild clinical improvement. Osteoporosis was revealed on a dual-energy x-ray absorptiometry (DEXA) scan with a T score of –2.5 in the lumbar spine and –3.2 in femoral neck; however, we should consider that compression fractures may falsely increase bone mineral density. Bone mass was persistently low despite aggressive treatment with zoledronic acid, raloxifene, calcitriol, and calcium carbonate.
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