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Clinical Cases in mineral and bone metabolism

Bilateral atypical femoral fractures in macroprolactinoma with hypopituitarism: a case report

Case report, 345 - 347
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Several case series have indicated that atypical femoral fractures (AFF) are associated with prolonged used of anti-resorptive agents. However, very few reports have demonstrated relationship between AFF and other osteoporosis-related conditions. We report a 63-year-old man with an unremarkable past medical history who suffered bilateral AFFs. He was never exposed to any antiresorptive therapy. Prolactin-producing pituitary adenoma
was diagnosed from very high serum prolactin level and a pituitary macroadenoma from MRI findings. Other pituitary functions revealed hypopituitarism (growth hormone deficiency, hypogonadotropic hypogonadism, central hypothyroidism and secondary adrenal insufficiency).
His bone mineral density showed osteoporosis by a dual-energy X-ray absorptiometry. The osteoporosis was considered to be secondary from growth hormone deficiency and hyperprolactinemia-induced hypogonadism. Interestingly, the measurement of bone
markers revealed suppressed bone resorption. To our knowledge, this is the first report of bilateral AFFs in a male patient who was diagnosed with osteoporosis from macroprolactinoma and hypopituitarism. This highlights that other factors, besides the use of anti-resorptive agents, can be related to AFF. Suppression of bone resorption markers in such conditions might be one of the main contributing factors.

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

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