Severe symptomatic osteopenia in a man with pigmented micronodular adrenal hyperplasia

The authors describe the unusual case of a 52-year-old man with Cushing's syndrome caused by bilateral pigmented micronodular adrenal hyperplasia. The only features of hypercortisolism were hypertension and severe symptomatic osteopenia with vertebral, rib, and scapular fractures. Four years after bilateral adrenalectomy, the bone density had increased slightly, but the patient remained osteopenic and continued to have vertebral compression fractures. This case report emphasizes the importance of an indepth search for secondary causes of osteoporosis, including evaluation of adrenal function in patients who have unexplained osteoporosis. Early diagnosis and treatment is imperative to prevent severe bone loss and associated skeletal morbidity.