MON-403 Osteoporosis: A Frequently Neglected Consequence of Cushing's Disease

INTRODUCTION: Osteoporosis is often associated with states of hypercortisolism such as Cushing’s Disease (CD). It occurs through different mechanisms: decreased intestinal calcium absorption, bone formation and renal calcium reabsorption and increased bone resorption. Our aim is to emphasize osteoporosis as a serious complication of CD and the need to screen all patients with hypercortisolism. CASE REPORT: Fifty three years old man, referred to the endocrinology department for follow up after gastric bypass performed one year earlier. He had history of gastric banding with weight regain. No Endocrine cause for obesity, prior to both surgical procedures, was evaluated. The patient complained of bone pain with gait and other activities limitation. At physical examination, he presented several signs suggestive of CD: facial plethora, centripetal obesity, vinous striae, acanthosis nigricans and proximal myopathy. 24-hour urine cortisol was elevated (> 600ug / 24h). Confirmatory tests were also suggestive of the diagnosis of CD (Liddle test with cortisol of 20 ug/dl), and Magnetic Resonance demonstrated the presence of a pituitary macroadenoma with 9.6x22.3mm. The patient performed osteodensitometry of the lumbar spine and femur which showed a T-score of -3.4, compatible with osteoporosis, and a CT scan that revealed "bilateral fractures of practically all costal arches". Pharmacological treatment for osteoporosis was initiated and the patient underwent transphenoidal surgery without complete removal of the lesion. CONCLUSION: The contribution of bariatric surgery in the treatment of obesity is undeniable. The present case illustrates the importance of an appropriate endocrine evaluation of all patients enrolled for this procedures and emphasizes the need for timely diagnosis of osteoporosis in patients with hypercortisolism, in order to prevent its potentially incapacitating and irreversible consequences.