Bilateral Adrenal Adenoma Presented As Multiple Metatarsal And Phalangeal Fractures.
BACKGROUND
Symptomatic adrenal adenoma usually presents with systemic symptoms. Depending on the function of the adenoma, the patient can present with pheochromocytoma-like symptoms; primary hyperaldosteronism and Cushing syndrome (weight gain, weakness, depression, and bruising).


METHODS
A 41 year-old lady presented with multiple metatarsal and phalangeal fractures of the both feet without significant injury. DEXA scan showed evidence of osteoporosis. Investigations showed that the picture was compatible with adrenal Cushing syndrome. Computed tomogram showed bilateral adrenal adenoma. Adrenal cortex scintigraphy with NP-59 scan showed hyperfunctioning right adrenal adenoma. Laproscopic R adrenalectomy was performed and histological study confirmed adrenal cortical adenoma with adjacent cortical atrophy suggestive of a functioning adenoma. Post-operatively, she was put on hydrocortisone replacement and recovered well.


CONCLUSIONS
Adrenal adenoma can present with insufficiency fractures of the feet.
Department of Orthopaedics and Traumatology, North District Hospital 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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LiYeung
Department of Orthopaedics and Traumatology, North District Hospital 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Lui
Cushing syndrome; insufficiency fracture; secondary osteoporosis; stress