Cushing’s syndrome found in case of man, 22, with severe osteoporosis
Early ID still 'best way' to prevent disease progression: Report
For a young man in Brazil, Cushing’s syndrome caused by nodules in both adrenal glands was found to be the reason for his severe osteoporosis — a condition that causes bones to weaken and become prone to fracture — according to a case report.
While noting that “the diagnosis of Cushing’s syndrome is always challenging,” the researchers highlighted that “osteoporosis is often associated with this condition.” Thus, in cases of severe osteoporosis, clinical testing may be useful in determining a potential diagnosis of the rare disorder.
“The early identification of Cushing’s syndrome, with measures based on the assessment of risks and benefits, remains the best way to prevent its progression and reduce the [symptoms] of the condition,” the researchers wrote.
The study, “Severe osteoporosis in a young man with bilateral Cushing’s syndrome: a case report,” was published in the Journal of Medical Case Reports.
Osteoporosis more often found in women
Cushing’s syndrome, a group of disorders that includes Cushing’s disease, occurs when the body has too much cortisol, a steroid hormone made naturally in the adrenal glands located atop the kidneys.
It can occur due to adrenal nodules, or tumors, which can be benign (noncancerous) or malignant (cancerous).
Having excess cortisol over a long period of time usually leads to weight gain, a round face and a buildup of fat at the base of the neck, and stretch marks.
Many people also experience other symptoms of Cushing’s, such as hypertension, or high blood pressure, and osteopenia, which is a loss of bone density. Some patients will have a more severe form of osteopenia, known as osteoporosis, which can lead to fractures, commonly in the hip, wrist or spine.
While bone loss is more common in women than men, anyone with an adrenal tumor is prone to develop osteopenia or osteoporosis.
That’s what happened in the case of a 20-year-old man from Brazil, according to a new report. The man was treated at the hospital after eight months of lower back pain.
An X-ray of the spine revealed fragility fractures, which occur when the bones are brittle, and scoliosis, or a sideways curve in the spine. A bone density test revealed the presence of osteoporosis.
For severe osteoporosis, patient given medication used in bone disease
To treat this severe osteoporosis, doctors prescribed a vitamin D supplement and a weekly dose of alendronate, a medication that slows the rate at which bone tissue is broken down in the body.
However, a physical examination also revealed purple stretch marks, a round face, and a fatty hump, as well as bruised skin, thin arms and thighs, a large belly, and a hunched back. All of these are signs of Cushing’s syndrome.
The man’s resting blood pressure, measured while sitting still, also was higher than normal.
A blood test revealed a cortisol level also higher than is normal, at 26.2 mcg/dL. That level remained at 24.1 mcg/dL after the patient took 1 mg of dexamethasone, a steroid that normally causes cortisol levels to drop. When it doesn’t, it indicates the presence of Cushing’s syndrome.
A CT scan revealed a 1.5-cm nodule in the left adrenal gland and another smaller nodule, measuring 0.6 cm, in the right adrenal gland.
These observations led doctors to suspect Cushing’s syndrome and to prescribe ketoconazole, an antifungal medication that can help keep cortisol levels under control. The man also was prescribed ramipril to lower blood pressure, and given an increased dose of vitamin D.
Because the patient’s osteoporosis was severe, the team also decide to replace alendronate with zoledronic acid, a medication used to treat many forms of bone disease.
After six months, the man’s cortisol levels dropped. Doctors then decided to remove the left adrenal gland via adrenalectomy, even though its nodule was likely to be benign based on MRI findings.
Removing only one adrenal gland, and not both, was done “to avoid a definitive adrenal insufficiency condition because of bilateral adrenalectomy” — that is, to prevent the body from being unable to produce a sufficient amount of cortisol following the removal of both adrenal glands.
“Despite the unavailability of genetic analysis for a precise etiological definition [cause of disease], it is possible to take efficient measures to avoid future damage,” the researchers wrote.