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Case Reports
. 2018 Oct-Dec;17(4):225-227.
doi: 10.4103/aam.aam_75_17.

Avascular necrosis of the femoral head: An exceptional complication of cushing's disease

Nadia Belmahi  1 , Saïd Boujraf  2 , Maazou Mahamane Larwanou  1 , Hanan El Ouahabi  1
Affiliations
Case Reports

Avascular necrosis of the femoral head: An exceptional complication of cushing's disease

Nadia Belmahi et al. Ann Afr Med. 2018 Oct-Dec.

Abstract
in English, French

Avascular necrosis (AVN) of the femoral head is a well-recognized complication of steroid treatment. Exogenous glucocorticoids' administration and alcoholism are the most common nontraumatic etiologies. AVN secondary to endogenous hypercortisolism (HC) is rare; very few case reports are available on this complication. We describe a 28-year-old female that has presented an AVN with Cushing's syndrome. Biochemical investigations confirmed HC. Magnetic resonance imaging (MRI) showed a pituitary adenoma that was resected transsphenoidally. The postoperative failure directed to radiosurgery treatment. Then, the patient then expressed a significant clinical improvement while developing adrenocorticotropic deficiency; hence, steroids were indicated. During the discovery of Cushing disease, the patient presented also limping and progressive pain in right hip. The pelvis MRI showed an AVN of the right femoral head. The patient underwent a total replacement of the right hip sine presenting an extensive AVN. This case elucidates that AVN could be an early manifestation of Cushing's disease.

Résumé L'osteonécrose avasculaire (ONAV) de la tête fémorale est une complication bien reconnue des traitements par des corticostéroïdes. L'administration de glucocorticoid exogène et l'alcoolisme sont les étiologies non-traumatiques les plus communes. L'ONVA secondaire à hypercortisolism endogène (HC) est rare; très peu de rapports de cas sont disponibles sur cette complication. Nous décrivons une femme de 28 ans qui a présenté un ONAV avec le syndrome de Cushing. Les études biochimiques ont confirmé HC. L'imagerie par résonance magnétique (IRM) a montré un adénome pituitaire qui a été réséqué de façon trans-sphénoïdal. L'échec post-opératoire a orienté au traitement par radiochirurgie. Ce dernier traitement a permis une amélioration clinique significative tout en développant une déficience adrenocorticotropique; d'où, l'intérêt d'avoir indiqué les corticostéroïdes. Pendant la découverte de maladie Cushing, le patient avait présenté aussi un boitement avec douleur progressive dans la hanche droite. L'IRM du bassin a montré un ONAV de la tête fémorale droite. La patiente a subi un remplacement total du sinus droit de hanche présentant un ONAV étendue. Ainsi ce cas élucide bien que l'ONAV pourrait être une manifestation précoce de la maladie de Cushing Mots-clés: Avasculaire, nécroses, Maladie de Cushing, hypercortisolism endogène.

Keywords: Avascular necrosis; Cushing's disease; endogenous hypercortisolism.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Magnetic resonance imaging of pelvis showing avascular necrosis of right femoral head
See this image and copyright information in PMC

References

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