title: An unusual case of hypercortisolism with multiple weight-bearing bone fractures.
abstract: Glucocorticoid excess, either from exogenous exposure or through endogenous overproduction, is a common cause of secondary osteoporosis. We report a 52-year-old woman presenting with multiple stress fractures of the lower extremities, despite various osteoporosis therapeutic regimens. Investigations led to the diagnosis of hypercortisolism of pituitary origin. Pituitary surgery was unsuccessful, justifying a treatment of ketoconazole. In the absence of densitometric osteoporosis, assessment of bone microstructure using high resolution peripheral quantitative computed tomography revealed alterations of both the cortical and trabecular compartments. This case illustrates that hypercortisolism may cause bone fragility in the absence of marked changes in areal bone mineral density.
authors.affiliation: Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Georgios
authors.initials: G
authors.lastname: Papadakis
authors.affiliation: Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Uebelhart
authors.affiliation: Endocrinology practice, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Goumaz
authors.affiliation: Division of Nuclear Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Sophie
authors.initials: S
authors.lastname: Zawadynski
authors.affiliation: Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Rene
authors.initials: R
authors.lastname: Rizzoli
keywords: Cushing’s syndrome; bone mineral density; fractures; glucocorticoids; secondary osteoporosis