EXOGENOUS CUSHING’S SYNDROME, ADDICTION TO ORAL DEXAMETHASONE AS PAIN KILLER: PITFALLS OF SKELETON EFFECTS AND DECISION MAKING

Florica Sandru; Bianca Maria Petrescu; Alexandru Florin Florescu; Anda Dumitrascu; Mara Carsote; Oana Claudia Sima; Anca Pati Cucu; Claudiu Nistor

doi:10.33695/rjcr.v6i2.210

Florica Sandru Department of Dermatology, ”Carol Davila” University of Medicine and Pharmacy, Bucharest
Bianca Maria Petrescu 2. Department of Dermatovenerology, Elias University Emergency Hospital, Bucharest, Romania
Alexandru Florin Florescu Endocrinology Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania & Endocrinology Department, "Sf. Spiridon" Emergency County Clinical Hospital, Iasi, Romania
Anda Dumitrascu Department of Radiology and Medical Imaging, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
Mara Carsote Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Department V of Clinical Endocrinology, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
Oana Claudia Sima Department V of Clinical Endocrinology, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania & PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Anca Pati Cucu PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania & Thoracic Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania
Claudiu Nistor Thoracic Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest, Romania & Department 4 - Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

DOI: https://doi.org/10.33695/rjcr.v6i2.210

Keywords: Cushing’s syndrome,, osteoporosis, fracture, DXA, surgery, dexamethasone

Abstract

Chronic use of glucocorticoids, either as medical recommendation or as self-administration for bone and joint long-standing pain, might cause negative effects such as inducing Cushing’s syndrome that embraces a large panel of clinical manifestations and bone impact might be one of them. We aim to introduce an adult male case who developed Cushing’s syndrome following the daily use of oral dexamethasone for chronic spine pain after undergoing spine surgery. Additionally, he developed vertebral fractures requiring neurosurgery, but continued to voluntarily use the drug. However, DXA (Dual-Energy X-Ray Absorptiometry) assessment was non usable for lumbar spine evaluation and proved no lowering of the bone mineral density at non-lumbar sites. Despite discordances between DXA results and prevalent fractures, a difficult decision amid specific medication against osteoporosis was taken, including the acumen of following the expected improvement of bone status over the time. Prolonged self-administration of corticoids for persistent post-operatory pain might bring negative bone effects in terms of multiple fractures requiring second time surgery that add to the already present component of persistent back pain. However, the tools we currently have to assess glucocorticoids-induced osteoporosis such as DXA and trabecular bone score might not be applicable in certain cases, thus the decision of medication against osteoporosis is based on the clinical panel (exogenous Cushing’s syndrome) and suppressed serum bone turnover markers. Poor compliance to glucocorticoids withdrawal as well as adherence to medication against osteoporosis represented another issue in this instance.

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