Document Type
Conference Proceeding
Publication Date
5-3-2024
Abstract
Introduction: Cushing's disease, arising from a pituitary macroadenoma, is marked by excessive cortisol production. Labs usually signify overproduction of adrenocorticotropic hormone (ACTH), leading to elevated cortisol levels. While cortisol is essential for various physiological functions, its excess can result in various symptoms and complications associated with Cushing's disease. Notably, individuals with this condition may experience an association with compression fractures, particularly in the vertebrae, due to weakened bones. Prolonged exposure to elevated cortisol levels contributes to the development of osteoporosis, characterized by weakened bone density, making fractures more likely. These compression fractures can manifest as localized or radiating back pain, a gradual loss of height over time, and kyphosis. Case: 43 year old female with pertinent past medical history of HFpEF, HTN, OSA, T2DM on insulin and morbid obesity who presented to the emergency room with complaints of intractable low back pain. CT of the abdomen and pelvis demonstrated age-indeterminate mild compression fractures of T8, T9, as well as T11 through L3, favored to be remote. She worked with physical therapy and was only able to sit up with her legs off the side of the bed, unable to walk. Patient was found to have hypercortisolemia on lab work. Her cortisol and ACTH was 29.1 and 313 respectively. MRI pituitary was completed and revealed a pituitary macroadenoma measuring greatest diameter of 3.3 cm. Patient was without visual symptoms but symptomatic given elevated ACTH, cortisol, glucose, multiple compression fractures, and overall clinical picture consistent with Cushing disease. The patient denied any facial plethora changes, denies history of anxiety/depression, prolonged steroid therapy, or use of megestrol acetate. The patient denied tobacco use, admits to social alcohol use stated as 2-3 glasses of wine on 3 out of 7 days weekly and denies illicit drug use. The patient denied any personal or family history of adrenal or autoimmune disease. Discussion: Patient was found to have Cushing's disease with a 3.3 cm pituitary macroadenoma. Given this information, patient needed a complete pituitary hormonal profile to evaluate for hypopituitarism, including free T4, free T3, prolactin, IGF-1. She was found to have secondary hypothyroidism secondary to pituitary macroadenoma and was started on 75 mcg of levothyroxine for replacement. Neurosurgery was consulted for resection of pituitary mass and patient underwent a trans- sphenoidal tumor resection. Conclusion: In summary, Cushing's disease which is often triggered by a pituitary macroadenoma can present in various ways. It is important to consider it in younger females with compression fractures. This patient was also obese and in this population there is a low risk of osteoporosis. Thus, in this population, when there is a presence of fractures it is important to consider other causes such as Cushing's disease. Ultimately, a comprehensive approach is essential to address both endocrine and skeletal abnormalities in these clinical scenarios.
Recommended Citation
Mcheik N, Banka A. Pituitary Cushing's disease and compression fractures: a case presentation. Presented at: American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day; 2024 May 3; Troy, MI.
Comments
American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day, May 3, 2024, Troy, MI