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Cardiel, Victoria Navarro Compan, Juan Piedra Priego, Ana González" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Nadia" "apellidos" => "Abdel-Kader" "email" => array:1 [ 0 => "greendoggy@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Mario H." "apellidos" => "Cardiel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Victoria" "apellidos" => "Navarro Compan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Juan" "apellidos" => "Piedra Priego" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Ana" "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Dr. Miguel Silva Hospital, Morelia, Mexico" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad de Cushing como causa de osteoporosis grave. Un reto clínico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1320 "Ancho" => 2167 "Tamanyo" => 176158 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Severe stage 3 dorsal vertebral fractures (arrows), moderate stage 1–2 dorsal fracture. (B) Fracture of the upper sternal body.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Secondary osteoporosis has been associated with different diseases and drugs.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> These include endocrine diseases, cancer, kidney damage, gastrointestinal and rheumatic diseases. Steroids are also a well-recognized cause of bone mass loss.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> According to some studies, 20%–30% of postmenopausal women and over 50% of men have a second cause of osteoporosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Endogenous Cushing's syndrome is characterized by excessive production of steroids, the most common cause being Cushing's disease due to a pituitary adenoma secreting ACTH.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A female, 41, attended the emergency department with generalized musculoskeletal pain, especially in the chest, spine and groin. Initial radiographs showed multiple fractures of the upper third of the sternal body, two severe stage 3 dorsal vertebral fractures and a third stages 1–2 dorsal fracture, with another on the ischiopubic ramus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). On examination hypertension and cushingoid features, such as round face and ce obesity were later found. Laboratory studies showed that cortisol and baseline ACTH determination were elevated. The baseline cortisol was 319<span class="elsevierStyleHsp" style=""></span>ng/ml (normal between 50 and 250<span class="elsevierStyleHsp" style=""></span>ng/ml) and ACTH of 57.4<span class="elsevierStyleHsp" style=""></span>pg/ml when it is normally undetectable or less than 10<span class="elsevierStyleHsp" style=""></span>pg/ml, with a decreased gonadotropin level. The levels of urinary free cortisol and cortisol were also elevated at night: 847<span class="elsevierStyleHsp" style=""></span>nmol/l and 290.7<span class="elsevierStyleHsp" style=""></span>ng/ml, respectively. The nocturnal cortisol under normal conditions is negligible. A cranial MRI showed a questionable image in the pituitary, so catheterization of inferior petrosal sinus was performed to study the source of ACTH overproduction. There was a central-peripheral gradient of ACTH and increased focus on the left half of the hypophysis. A second MRI detected a nodule of 6.3<span class="elsevierStyleHsp" style=""></span>mm in the posterior left area of the pituitary. Following these results the patient was diagnosed as having Cushing's disease due to a pituitary microadenoma. The patient was treated from the surgical standpoint with a hemihypophysectomy of the microadenoma, and infused intravenously (iv) with zoledronic acid 5<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>iv<span class="elsevierStyleMonospace">/</span>year as a treatment for severe osteoporosis, with great improvement of bone pain. After surgery, cortisol levels were normalized with baseline cortisol levels of 152<span class="elsevierStyleHsp" style=""></span>ng/ml and urinary cortisol of 107<span class="elsevierStyleHsp" style=""></span>nmol/l.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Although osteoporosis is a cardinal manifestation of Cushing's<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> syndrome, there are few publications in this respecto.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The incidence of Cushing's syndrome of endogenous origin is 2–4 cases per million inhabitants/year.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Its diagnosis requires a high clinical suspicion, as most of the symptoms of this syndrome are highly prevalent in the general population (hypertension, glucose intolerance, central obesity, osteoporosis) and none of these is specific.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Fractures occur in 19%–50% in patients with Cushing's disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the last 5 years, we have only found two case reports of fractures secondary to osteoporosis due to Cushing's<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> disease.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Our patient presented with spontaneous fractures as a sentinel manifestation of Cushing's disease, and in this case the causal diagnosis of osteoporosis had highly relevant prognostic and therapeutic implications.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0020" class="elsevierStylePara elsevierViewall">We must always consider the possibility of secondary osteoporosis after the appearance of a spontaneous fracture, especially in men and premenopausal and perimenopausal women, where the frequency of secondary osteoporosis is near/greater than 50%.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects</span>. The authors declare that no experiments were performed on humans or animals for this investigation.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of Data</span>. The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent</span>. The authors have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence is in possession of this document.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Disclosures</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no disclosures to make.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres125906" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec113200" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres125905" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec113201" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Ethical disclosures" ] 9 => array:2 [ "identificador" => "sec0025" "titulo" => "Disclosures" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-08-09" "fechaAceptado" => "2011-11-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec113200" "palabras" => array:3 [ 0 => "Cushing's disease" 1 => "Fractures" 2 => "Secondary osteoporosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec113201" "palabras" => array:3 [ 0 => "Enfermedad de Cushing" 1 => "Fracturas" 2 => "Osteoporosis secundaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Secondary osteoporosis is a frequently underestimated bone disorder. It is a secondary cause of bone loss that affects more than half of men and premenopausal and perimenopausal women, and about one-fifth of postmenopausal women. We herein report an uncommon case of multiple fractures due to secondary osteoporosis caused by Cushing's disease. In this case the appearance of fractures in a 41 years old woman was the sign of alarm that ultimately led us to the diagnosis.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La osteoporosis secundaria está frecuentemente infraestimada en el estudio de la osteoporosis. Existe una causa segunda de osteoporosis en cerca o más de la mitad de hombres y mujeres premenopáusicas, y en torno a un quinto de las mujeres posmenopáusicas. Presentamos a una mujer de 41 años, con dolor óseo por fracturas múltiples, cuyo diagnóstico final fue enfermedad de Cushing.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Abdel-Kader N, et al. Enfermedad de Cushing como causa de osteoporosis grave. Un reto clínico. Reumatol Clin. 2012. <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2011.11.004">doi:10.1016/j.reuma.2011.11.004</span></p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1320 "Ancho" => 2167 "Tamanyo" => 176158 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Severe stage 3 dorsal vertebral fractures (arrows), moderate stage 1–2 dorsal fracture. (B) Fracture of the upper sternal body.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Secondary osteoporosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Stein" 1 => "E. Shane" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Endocrinol Metab Clin North Am" "fecha" => "2003" "volumen" => "32" "paginaInicial" => "115" "paginaFinal" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12699295" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Secondary causes of osteoporosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. 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Year/Month | Html | Total | |
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2024 November | 15 | 15 | 30 |
2024 October | 164 | 54 | 218 |
2024 September | 187 | 31 | 218 |
2024 August | 195 | 60 | 255 |
2024 July | 237 | 47 | 284 |
2024 June | 203 | 34 | 237 |
2024 May | 217 | 38 | 255 |
2024 April | 194 | 33 | 227 |
2024 March | 198 | 27 | 225 |
2024 February | 114 | 38 | 152 |
2024 January | 132 | 22 | 154 |
2023 December | 114 | 33 | 147 |
2023 November | 114 | 33 | 147 |
2023 October | 113 | 35 | 148 |
2023 September | 138 | 39 | 177 |
2023 August | 91 | 21 | 112 |
2023 July | 94 | 26 | 120 |
2023 June | 83 | 25 | 108 |
2023 May | 111 | 26 | 137 |
2023 April | 119 | 17 | 136 |
2023 March | 162 | 31 | 193 |
2023 February | 99 | 33 | 132 |
2023 January | 98 | 31 | 129 |
2022 December | 94 | 56 | 150 |
2022 November | 140 | 59 | 199 |
2022 October | 107 | 42 | 149 |
2022 September | 83 | 58 | 141 |
2022 August | 87 | 38 | 125 |
2022 July | 83 | 52 | 135 |
2022 June | 98 | 52 | 150 |
2022 May | 110 | 45 | 155 |
2022 April | 113 | 52 | 165 |
2022 March | 123 | 70 | 193 |
2022 February | 117 | 40 | 157 |
2022 January | 118 | 58 | 176 |
2021 December | 110 | 43 | 153 |
2021 November | 104 | 50 | 154 |
2021 October | 132 | 69 | 201 |
2021 September | 89 | 53 | 142 |
2021 August | 100 | 39 | 139 |
2021 July | 72 | 32 | 104 |
2021 June | 96 | 61 | 157 |
2021 May | 108 | 50 | 158 |
2021 April | 205 | 110 | 315 |
2021 March | 153 | 52 | 205 |
2021 February | 70 | 29 | 99 |
2021 January | 78 | 27 | 105 |
2020 December | 66 | 28 | 94 |
2020 November | 104 | 31 | 135 |
2020 October | 78 | 30 | 108 |
2020 September | 59 | 39 | 98 |
2020 August | 54 | 24 | 78 |
2020 July | 43 | 29 | 72 |
2020 June | 67 | 29 | 96 |
2020 May | 54 | 16 | 70 |
2020 April | 53 | 31 | 84 |
2020 March | 25 | 17 | 42 |
2020 February | 2 | 0 | 2 |
2019 September | 0 | 1 | 1 |
2019 July | 0 | 1 | 1 |
2019 April | 0 | 2 | 2 |
2019 February | 0 | 1 | 1 |
2019 January | 1 | 0 | 1 |
2018 June | 0 | 3 | 3 |
2018 May | 6 | 7 | 13 |
2018 April | 81 | 11 | 92 |
2018 March | 88 | 18 | 106 |
2018 February | 65 | 5 | 70 |
2018 January | 59 | 9 | 68 |
2017 December | 67 | 10 | 77 |
2017 November | 71 | 19 | 90 |
2017 October | 64 | 10 | 74 |
2017 September | 43 | 20 | 63 |
2017 August | 80 | 18 | 98 |
2017 July | 59 | 8 | 67 |
2017 June | 95 | 38 | 133 |
2017 May | 110 | 13 | 123 |
2017 April | 106 | 11 | 117 |
2017 March | 164 | 43 | 207 |
2017 February | 370 | 13 | 383 |
2017 January | 167 | 17 | 184 |
2016 December | 207 | 18 | 225 |
2016 November | 188 | 14 | 202 |
2016 October | 242 | 20 | 262 |
2016 September | 267 | 9 | 276 |
2016 August | 175 | 9 | 184 |
2016 July | 118 | 9 | 127 |
2016 June | 0 | 9 | 9 |
2016 May | 1 | 16 | 17 |
2016 April | 0 | 13 | 13 |
2016 February | 1 | 11 | 12 |
2016 January | 0 | 17 | 17 |
2015 December | 4 | 0 | 4 |
2015 October | 2 | 0 | 2 |
2015 August | 3 | 0 | 3 |
2015 July | 105 | 6 | 111 |
2015 June | 121 | 4 | 125 |
2015 May | 146 | 12 | 158 |
2015 April | 157 | 7 | 164 |
2015 March | 185 | 5 | 190 |
2015 February | 147 | 12 | 159 |
2015 January | 124 | 9 | 133 |
2014 December | 122 | 8 | 130 |
2014 November | 125 | 9 | 134 |
2014 October | 123 | 6 | 129 |
2014 September | 92 | 7 | 99 |
2014 August | 77 | 11 | 88 |
2014 July | 69 | 13 | 82 |
2014 June | 78 | 11 | 89 |
2014 May | 79 | 21 | 100 |
2014 April | 106 | 16 | 122 |
2014 March | 78 | 17 | 95 |
2014 February | 56 | 11 | 67 |
2014 January | 55 | 10 | 65 |
2013 December | 46 | 7 | 53 |
2013 November | 50 | 12 | 62 |
2013 October | 54 | 13 | 67 |
2013 September | 57 | 14 | 71 |
2013 August | 60 | 15 | 75 |
2013 July | 35 | 7 | 42 |
2013 June | 59 | 6 | 65 |
2013 May | 57 | 8 | 65 |
2013 April | 45 | 12 | 57 |
2013 March | 48 | 10 | 58 |
2013 February | 43 | 9 | 52 |
2013 January | 50 | 15 | 65 |
2012 December | 36 | 25 | 61 |
2012 November | 25 | 25 | 50 |
2012 October | 24 | 21 | 45 |