Bilateral femoral head avascular necrosis with a very low dose of oral corticosteroid used for panhypopituitarism

Dharmshaktu, Pramila; Aggarwal, Aditya; Dutta, Deep; Kulshreshtha, Bindu

doi:10.1136/bcr-2015-212803

Cited by 8 publications

(12 citation statements)

References 14 publications

(17 reference statements)

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“…Postdiagnosis steroid dosages were decreased to 7.5 mg/day and 15 mg/day, respectively. Similar to our case, Dharmshaktu et al reported bilateral femoral head AVN, in a 38-year-old man, 2 years after initiation of low-dose glucocorticoid replacement (prednisolone 5 mg daily, equivalent to hydrocortisone 20 mg) for secondary adrenal insufficiency after surgery for a non-secreting pituitary adenoma 11. Postdiagnosis, the patient was switched to hydrocortisone/Cortef 15 mg daily.…”

Section: Discussionsupporting

confidence: 85%

Bilateral osteonecrosis of the hip in panhypopituitarism

Uppal

Burbridge

Arnason³

2019

BMJ Case Rep

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Osteonecrosis, also known as avascular necrosis, is a condition that causes significant morbidity and loss of function. It is a common complication seen with supraphysiological steroid use. Early diagnosis is critical as it impacts prognosis. We report a 20-year-old man who developed bilateral osteonecrosis of the hip following 6 years of low-dose steroid replacement therapy for panhypopituitarism secondary to a transsphenoidal resection of a growth hormone-secreting pituitary macroadenoma. The patient presented with several weeks of right-sided hip pain and significant loss of function. X-ray and MRI showed bilateral osteonecrosis of the hips with the right side more severely affected than the left. He was initiated on analgesics and bisphosphonates and underwent right hip total arthroplasty followed 1 year later by left hip arthroplasty. Postsurgery, the patient is mobilising well and his pituitary hormones are well balanced. He continues on low-dose glucocorticoid replacement which will continue lifelong.

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Section: Discussionsupporting

confidence: 85%

Bilateral osteonecrosis of the hip in panhypopituitarism

Uppal

Burbridge

Arnason³

2019

BMJ Case Rep

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“…Unilateral AVN (right hip) * 2 Dharmshaktu et al, [5] 38/M 5 mg prednisolone for hypopituitarism 2 years Bilateral AVN Surgery, zoledronic acid, calcium, vitamin D 3 Hossain et al, [8] 41/F 25 mg hydrocortisone for hypopituitarism Rajput et al, [6] within the bone, and apoptosis could be possible mechanisms. [2,10] In a study of 66 steroid-induced AVN cases, the most common associated route involved was intravenous steroids followed by oral and rarely intramuscular, intraarticular injections, and inhaled steroids.…”

Section: Yearsmentioning

confidence: 99%

“…However, the patient had menopause, which could be a contributing factor for steroid-induced osteonecrosis. Dharmshaktu et al [5] reported bilateral AVN with 5 mg/day dose of oral prednisolone therapy over a duration of two years. However, the patient had a history of dexamethasone therapy at a dose of 2 mg/day before prednisolone therapy.…”

Section: Yearsmentioning

confidence: 99%

Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review

et al. 2020

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usually, such doses are used for immunosuppressive, chemotherapeutic, or anti-inflammatory effects. Since the usual doses used in endocrinology are physiological doses given as replacement for steroid deficiency, this complication is rarely seen in endocrinology practice. A few cases of osteonecrosis due to the physiologic dose of glucocorticoids have been reported in the literature. [5-8] However, some of these patients had a history of steroid use prior to pituitary surgery or

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“…[ 13 ] Dharmshaktu et al . [ 14 ] reported an occurrence of bilateral ONFH with a physiological replacement dose of glucocorticoids in a 38-year-old man with nonsecreting pituitary adenoma.…”

Section: Etection In the E Arlier mentioning

confidence: 99%

Corticosteroid-induced Osteonecrosis of the Femoral Head

Liu

Zhang

Sun

et al. 2017

Chinese Medical Journal

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Objective:This review aimed to provide a current recommendation to multidisciplinary physicians for early detection, diagnosis, and treatment of corticosteroid-induced osteonecrosis of the femoral head (ONFH) based on a comprehensive analysis of the clinical literature.Data Sources:For the purpose of collecting potentially eligible articles, we searched for articles in the PubMed, Cochrane Library, Embase, and CNKI databases up to February 2017, using the following key words: “corticosteroid”, “osteonecrosis of the femoral head”, “risk factors”, “diagnosis”, “prognosis”, and “treatment”.Study Selection:Articles on relationships between corticosteroid and ONFH were selected for this review. Articles on the diagnosis, prognosis, and intervention of earlier-stage ONFH were also reviewed.Results:The incidence of corticosteroid-induced ONFH was associated with high doses of corticosteroids, and underlying diseases in certain predisposed individuals mainly occurred in the first 3 months of corticosteroid prescription. The enhanced awareness and minimized exposure to the established risk factors and earlier definitive diagnosis are essential for the success of joint preservation. When following up patients with ONFH, treatment should be started if necessary. Surgical treatment yielded better results than conservative therapy in earlier-stage ONFH. The ideal purpose of earlier intervention and treatment is permanent preservation of the femoral head without physical restrictions in daily living.Conclusions:Clinicians should enhance their precaution awareness of corticosteroid-induced ONFH. For high-risk patients, regular follow-up is very important in the 1st year after high-dose prescription of corticosteroids. Patients with suspected ONFH should be referred to orthopedists for diagnosis and treatment in its earlier stage to preserve the joint.

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Bilateral femoral head avascular necrosis with a very low dose of oral corticosteroid used for panhypopituitarism

Cited by 8 publications

References 14 publications

Bilateral osteonecrosis of the hip in panhypopituitarism

Bilateral osteonecrosis of the hip in panhypopituitarism

Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review

Corticosteroid-induced Osteonecrosis of the Femoral Head

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