title: Lower extremity insufficiency fractures: an underappreciated manifestation of endogenous Cushing's syndrome.
abstract: This report describes the presence of lower extremity insufficiency fractures in 10 women prior to the clinical and biochemical diagnosis of endogenous Cushing's syndrome (CS). Osteoporosis is a well-recognized complication of overt CS resulting in a high rate of vertebral and other fractures. After institutional review board (IRB) approval, we did a retrospective chart review of patients with lower extremity (LE) insufficiency fractures (IF) and CS. This chart review found 10 women in whom LE-IF preceded the diagnosis of endogenous CS. Low bone density was found in all but one patient. The CS was considered to be mild (or subclinical) in five patients. LE-IF should be considered part of the skeletal spectrum of CS. Physicians caring for patients with LE-IF should have a low threshold for the consideration of CS even in patients without overt physical evidence of cortisol excess.
authors.affiliation: Department of Medicine (Endocrinology), Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: S
authors.initials: S
authors.lastname: Poonuru
authors.affiliation: Department of Medicine (Endocrinology), Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Findling
authors.affiliation: Department of Medicine (Endocrinology), Medical College of Wisconsin, Milwaukee, WI, USA. joseph.shaker@froedtert.com.
authors.forename: J L
authors.initials: JL
authors.lastname: Shaker
mesh_terms: D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000150:complications* / Q000175:diagnosis; D005260:Female; D015775:Fractures, Stress / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006854:Hydrocortisone; D035002:Lower Extremity; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006854:Hydrocortisone