以骨痛、骨质疏松为主要表现的库欣综合征1例报告  

Report of a case of Cushing's syndrome presented with bone pain and osteoporosis

作　　者：李昂[1] 高莹[1] 郭晓蕙[1] 

机构地区：[1]北京大学第一医院内分泌科,100034

出　　处：《北京医学》2016年第4期337-341,共5页Beijing Medical Journal

摘　　要：目的总结骨痛的发病机制及库欣综合征所致骨质疏松的临床特点。方法对1例"间断腰背痛2年,加重1周"为主诉、误诊为骨转移癌的库欣综合征患者进行临床分析及鉴别诊断,复习文献并总结其临床特点及预后。结果患者以多部位持续、进行性加重的骨痛为主要表现,通过小剂量地塞米松抑制试验定性诊断及影像学定位诊断,考虑非ACTH依赖的库欣综合征所致骨质疏松症产生骨痛,并通过实验室检查除外其他常见骨痛及继发骨质疏松病因。影响破骨活性、局部细胞因子水平以及产生骨破坏的疾病可产生骨痛。骨质疏松症为本病的重要表现,其发生率为50%;库欣综合征亦是继发性骨质疏松症常见原因。不同库欣综合征病因下骨质疏松程度有差异。库欣综合征获得治疗后,骨密度可逐渐改善;同时应用钙、维生素D及抑制破骨活性药物有助于预防骨折。结论对于骨痛为症状表现的疑难病例,应重视体格检查和内分泌检查,仔细寻找线索,并排除其他可引起骨痛的病因,以减少漏诊、误诊发生。Objective To understand the pathogenesis of bone pain and clinical characteristics of osteoporosis caused by Cushing syndrome. Methods We presented one case of Cushing syndrome misdiagnosed as metastases of bone with chief complaint of＂intermittent pain in the back for 2 years and aggravated for a week＂. Clinical analysis and differential diagnosis were carried out. The literature was reviewed and the clinical characteristics and prognosis were summarized. Results The main manifestation of the patient was sustained and progressive bone pain at multiple locations.With qualitative diagnosis of low- dose dexamethasone suppression test and imaging locative diagnosis, ACTH- independent Cushing syndrome was diagnosed. After exclusion of common causes of bone pain and secondary osteoporosis, Cushing syndrome was considered as the cause of osteoporosis that induces sustained bone pain. The diseases, which affected osteoclast activity or local cytokine levels or bone destruction, can produce bone pain. Osteoporosis is an important manifestation of Cushing syndrome with the incidence rate of up to 50%. Cushing syndrome is a common cause of secondary osteoporosis. The degree of osteoporosis varies depending on the etiology of Cushing syndrome. The bone mass density could be improved gradually after treatment for Cushing syndrome. Application of calcium supplementary, vitamin D preparation, and bone resorption inhibitor are also helpful for the prevention of fractures. Conclusion In order to minimize misdiagnosis of intractable case presented as bone pain, physical examination and endocrine examination should be considered to exclude other causes of bone pain.

关 键 词：骨痛 骨质疏松 库欣综合征 

分 类 号：R586.2[医药卫生—内分泌]