反覆發生脊椎壓迫性骨折可能暗示潛藏腎上腺腫瘤-案例報告以及文獻回顧
鄭百諭、李宏耕、吳維哲、曾一俢、鍾旭東
亞東紀念醫院 外科部 泌尿科
Repeated vertebral compression fracture may imply an adrenal tumor-a case report and review of literature
Pai-Yu Cheng, Hung-Keng Li, Wei-Che Wu, Yu-Shiou Tseng, Shiu-Dong Chung
Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
Introduction: Cushing’s syndrome with typical presentation such as central obesity, hirsutism, hypertension or glucose intolerance, can be easily perceived by clinical physician. However, recognizing subclinical Cushing’s syndrome or less common signs and symptoms is challenging to subspecialist, leading to delayed diagnosis and treatment.
Case report: A 48-year-old man presented with severe back pain without radiation. L2 and L5 vertebral compression fracture was noted from X ray and MRI, and vertebroplasty was performed by orthopedic surgeons. New onset of compression fracture developed over T9-12, L4-5 one month later. Severe osteoporosis was noted from hip BMD, and he was referred to endocrinologist. Serial endocrine survey confirmed hypercortisolism, and subsequent abdomen MRI showed left adrenal tumor with Cushing’s syndrome. Left adrenalectomy was performed, and the patient received Cortisol supplement in the following one year. No new fracture was identified.
Discussion: Pathological fracture as only manifestation was reported in few cases. Vertebra, rib and pubic bone were ever described. Surgery is the first line in treating functional adrenal tumor, and adrenal insufficiency usually presents postoperatively. Glucocorticoid replacement is advised in all patients after surgery, but only few patients need long term glucocorticoid supplement.
Conclusion: Cushing’s syndrome shall be considered and verified in middle-aged adult patients with severe osteoporosis and repeated vertebral compression fracture.