Nadir Bir Cushing Sendromu Olgusu: Fonksiyonel Hipofiz ve Adrenal Adenom BirlikteliğiA case of adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome, which develops in the course of ACTH-dependent Cushing's disease, is presented in this report. A 47-year-old woman with a past history of surgery and gamma knife radiosurgery because of Cushing's disease was admitted to the endocrinology clinic with weight gain and unregulated blood glucose levels. Hypercortisolemia was still persisting and diagnostic work-up indicated ACTH-independent Cushing's syndrome. Along with the rare possibility of this coexistence, longstanding ACTH hypersecretion can play a role in functional transition of adrenal adenomas. Further studies are needed to clarify the underlying mechanisms.Keywords: Cushing's syndrome, Cushing's disease, adrenal adenoma Bu olgu sunumunda aynı hastada adrenokortikotropik hormon (ACTH) bağımlı Cushing hastalığı seyrinde gelişen ACTH bağımsız Cushing sendromu sunulacaktır. Cushing hastalığı sebebiyle cerrahi ve gamma knife uygulanmış olan 47 yaşındaki hasta endokrinoloji kliniğine kilo alma ve regüle olmayan kan şekeri sebebiyle başvurmuştur. Yapılan tetkikler hiperkortizolemisinin bulunduğunu ve hiperkortizoleminin ACTH bağımsız hale geldiğini göstermiştir. Bu ko-insidansın çok nadir bir olasılık olmasıyla beraber, uzun dönem ACTH hipersekresyonu daha önceden fonksiyonel olmayan adrenal adenomun fonksiyonel hale gelmesinde rol oynamış olabilir. Bu konuda altta yatan mekanizmaların aydınlatılması için ileri araştırmalara ihtiyaç bulunmaktadır.

Pregnancy associated osteoporosis (PAO) is a rare disease characterized by multiple vertebral compression fractures, limitation of movement and severe back pain. A positive family history of PAO, decreased body mass index, sedentary life style, smoking, malnutrition and low calcium intake are among the risk factors of this disease. PAO should be considered in patients with back pain during pregnancy and postpartum period. As a specified therapy option is lack for PAO, discontinuation of lactation and the supplementation of calcium and vitamin D are the main steps of the treatment in patients who are planning to become pregnant in the future. The current data show that bisphosphonates should be avoided and teriparatide may be a treatment option in patients who are planning to become pregnant. In this case report, it was aimed to highlight the diagnosis and treatment approaches of PAO in a patient with back pain during postpartum period.