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Clinical Cases in mineral and bone metabolism

Severe secondary osteoporosis in a premenopausal woman: should a specific treatment for osteoporosis be started?

Case report, 115 - 118
doi: 10.11138/ccmbm/2018.15.1.115
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Abstract
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Introduction. Osteoporosis is one of the major complications in patients with endogenous Cushing’s syndrome (CS). We present the case of a severe osteoporosis secondary to a cortisol-secreting adrenal adenoma in a premenopausal woman. We have monitored bone mineral density (BMD) and bone turnover markers (BTMs) over a 9-years period following the surgical cure of Cushing’s syndrome.
The Case. A 33-year-old woman was diagnosed with severe osteoporosis and vertebral fractures. The physical examination raised the suspicion of a Cushing’s syndrome witch was further confirmed by various studies and proved to be caused by an adrenal adenoma. Osteoporosis was considered to be secondary to endogenous hypercortisolism.
A dual-energy X-ray absorptiometry (DXA) scan performed 2 months after successful surgery showed a significant spontaneous improvement in lumbar spine BMD. BTMs showed maximum values 5 months after surgery, followed by a gradual decrease to normal values.
A 9-years follow-up with yearly DXA and BTMs evaluations showed complete spontaneous BMD recovery with normal and stable BTMs, in the absence of any specific therapy for osteoporosis. Over this long period the patient did not present any new vertebral fracture.
Conclusion. Our case provides evidence that antiresorptive or teriparatide therapy might not be necessary in severe osteoporosis due to a cortisol-secreting adrenal adenoma after successful surgery, at least in premenopausal women.

Vol. XV (No. 3) 2018 September - December

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