Cushing’s syndrome cause of osteoporosis in young woman

Disease to be suspected in younger adults with 'non-violent vertebral fractures'

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Cushing’s syndrome should be considered when osteoporosis, or weak bones, are found in young adults, scientists in China reported.

They described treating a 26-year-old woman who came to their clinic with chronic back pain that X-rays identified as due to multiple bone fractures, and who exhibited a number of other classic Cushing’s features. Surgery to address Cushing’s, followed by conservative treatment regimens for her osteoporosis, was successful.

“For young patients with low-energy vertebral fractures, more attention must be paid on its etiology [cause], because … the first and most important thing is etiological treatment to eliminate the predisposition of Cushing’s syndrome, such as, treatment of pituitary tumors or primary adrenal lesions,” the scientists wrote.

The case report, “Osteoporotic vertebral compression fractures caused by Cushing’s syndrome in young women: case report and literature review,” was published in the journal BMC Musculoskeletal Disorders.

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Cushing’s syndrome is marked by excessive levels of the stress hormone cortisol. In cases where this excess is caused by a tumor in the brain’s pituitary gland, it’s known as Cushing’s disease.

Sustained high cortisol levels can drive a host of Cushing’s symptoms, including musculoskeletal problems like muscle weakness, low bone mineral density, or osteoporosis — a disease marked by brittle and fracture-prone bones.

Typically, osteoporosis is most commonly seen in people ages 50 and older. But it can be found in younger adults, especially young women, when it occurs secondarily to Cushing’s, the scientists noted.

For some Cushing’s patients, bone problems and associated pain may be among the first signs of the disease.

The woman had been seen at an outpatient facility with the scientists’ institute in Guizhou repeatedly over the previous year for lower back pain, and came to their hospital after the pain worsened in recent months.

An X-ray showed multiple fractures in her lower spine and pelvis, and she was admitted to the hospital. The fractures were non-traumatic, meaning they lacked a precipitating violent event like a bad fall.

The woman had high blood pressure and she reported having gained weight two years ago. She also had a number of physical features consistent with Cushing’s syndrome, including a moon face and buffalo hump due to fat buildup on the sides of the face and between the shoulder blades, as well as abdominal stretch marks.

Additional imaging tests confirmed the fractures and significant osteoporosis.

A Cushing’s syndrome diagnosis was confirmed after additional exams revealed high cortisol levels. A battery of tests to find the its cause ultimately identified a tumor on the left adrenal gland. These glands, which sit atop the kidneys, are responsible for cortisol production.

The woman underwent surgery to remove the gland, and her cortisol levels returned to normal within a day. However, her back pain continued to worsen and new fractures were identified.

She declined surgery for the osteoporosis, so the doctors recommended a conservative treatment regimen that included calcium and vitamin D supplements, alendronate, and salmon calcitonin, in addition to pain medications and a back brace.

During a follow-up phone call three months after her release from the hospital, the woman reported being free of pain and having returned to her regular life. She declined additional clinical examinations.

“For young patients with non-violent vertebral fractures, especially in women, it is necessary for us to consider the possibility of Cushing’s syndrome,” the scientists wrote, noting that understanding the cause of osteoporosis is important in deciding a  treatment approach.

For Cushing’s patients, the underlying cause of cortisol excess also needs to be addressed.

Given the risks of surgery and contradictory evidence regarding its effectiveness, “conservative treatments are recommended as a priority,” they wrote. Anti-osteoporosis medications, such as those used for this patient, should be given “the highest priority because of the reversibility of osteoporosis caused by Cushing’s syndrome.”