Spontaneous bone infarction of the distal femur in a patient with Cushing's disease: a case report

Abstract

Avascular necrosis of the femoral head is a well-known complication of treatment with high dosage glucocorticoids and has been described in a few patients with Cushing's syndrome. In this case report, we describe the, to our knowledge, first case of a patient with endogenous Cushing's syndrome with a bone infarction located in the distal femur. In patients with Cushing's syndrome and bone pain, the diagnosis of bone infarction should be considered as it can occur as a rare complication of hypercortisolism.

Keywords: ACTH, adrenocorticotropic hormone; ALL, acute lymphoblastic leukemia; AVN, avascular necrosis; Avascular necrosis; Bone infarction; CS, Cushing's syndrome; Cushing's disease; DST, 1 mg dexamethasone suppression test; LMWH, low-molecular weight heparin; MRI, magnetic resonance imaging; Osteonecrosis; n, normal value.

Fig. 1

Conventional X-ray of the left distal femur, showing intramedullary sheath-like lucencies in the distal femoral diaphysis.

Fig. 2

T2 weighted axial (left) and proton density weighted sagittal (right) MR images of the left distal femur with fat saturation. Serpenginous intramedullary high signal lines (arrows) surrounding normal fatty marrow (asterix) in the distal femoral diaphysis.