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Cushing's disease presenting with avascular necrosis of the hip: an orthopedic emergency

C A Koch1, C Tsigos, N J Patronas

  • 1Developmental Endocrinology Branch, National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1862, USA.

The Journal of Clinical Endocrinology and Metabolism
|September 16, 1999
PubMed

Insights

Avascular necrosis (AVN) of the hip can be an early sign of Cushing

Area of Science:

  • Endocrinology
  • Orthopedics
  • Radiology

Background:

  • Nontraumatic avascular necrosis (AVN) of the hip is typically linked to exogenous glucocorticoids.
  • Endogenous hypercortisolism, such as Cushing's syndrome (CS), is a rare cause of AVN.

Observation:

  • A 30-year-old woman with Cushing's disease presented with early-stage AVN of the hip.
  • Initial plain X-rays were negative, but MRI confirmed stage 2 AVN.
  • Orthopedic intervention with core decompression was performed before a CS diagnosis.

Findings:

  • The patient's femoral head recovered fully following early core decompression.
  • MRI is crucial for diagnosing early AVN, as radiographs can be falsely negative.
  • This case highlights AVN as a potential initial manifestation of CS.

Implications:

  • Early diagnosis and treatment of AVN are critical for a favorable prognosis.
  • Core decompression should be promptly initiated for suspected AVN, even before CS diagnosis.
  • Recognizing the link between AVN and CS is vital for timely endocrine management and orthopedic outcomes.

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