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

Osteonecrosis, commonly known as avascular necrosis (AVN) of bone, is one of the universally recognized side effects of high-dose steroids and commonly involves femur head leading to significant morbidity. However, the development of AVN in the femoral head due to low-dose oral corticosteroid therap...

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Autores principales: Çalapkulu, Murat, Kızılgül, Muhammed, Sencar, Muhammed Erkam, Düğer, Hakan, Uçan, Bekir, Çakal, Erman, Özbek, Mustafa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bayçınar Medical Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489177/
https://www.ncbi.nlm.nih.gov/pubmed/32584743
http://dx.doi.org/10.5606/ehc.2020.72773
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author Çalapkulu, Murat
Kızılgül, Muhammed
Sencar, Muhammed Erkam
Düğer, Hakan
Uçan, Bekir
Çakal, Erman
Özbek, Mustafa
author_facet Çalapkulu, Murat
Kızılgül, Muhammed
Sencar, Muhammed Erkam
Düğer, Hakan
Uçan, Bekir
Çakal, Erman
Özbek, Mustafa
author_sort Çalapkulu, Murat
collection PubMed
description Osteonecrosis, commonly known as avascular necrosis (AVN) of bone, is one of the universally recognized side effects of high-dose steroids and commonly involves femur head leading to significant morbidity. However, the development of AVN in the femoral head due to low-dose oral corticosteroid therapy in a short time is a rare occurrence. Management by stopping corticosteroid treatment can be challenging in many cases due to the adrenal crisis. Glucocorticoids may have to be continued in the lowest possible dose using a physiological preparation, such as hydrocortisone, when the stoppage is not possible. In this article, we report a 34-year-old male patient with hypopituitarism who developed bilateral AVN while receiving a mild physiological replacement oral prednisolone dose for only three years for secondary adrenal insufficiency of hypopituitarism after transsphenoidal surgery. The patient was switched to hydrocortisone and underwent core decompressive surgery resulting in a reduction of hip pain and improvement. The case report intends to highlight the occurrence of AVN of the femur even with a very low dose of corticosteroid used for the treatment of panhypopituitarism. Avascular necrosis should be considered in the differential diagnosis in patients with hip pain, even in low-dose steroid use because early diagnosis is essential to prevent progression, collapse, and eventually the need for hip replacement in AVN.
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spelling pubmed-74891772020-09-17 Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review Çalapkulu, Murat Kızılgül, Muhammed Sencar, Muhammed Erkam Düğer, Hakan Uçan, Bekir Çakal, Erman Özbek, Mustafa Jt Dis Relat Surg Case Report Osteonecrosis, commonly known as avascular necrosis (AVN) of bone, is one of the universally recognized side effects of high-dose steroids and commonly involves femur head leading to significant morbidity. However, the development of AVN in the femoral head due to low-dose oral corticosteroid therapy in a short time is a rare occurrence. Management by stopping corticosteroid treatment can be challenging in many cases due to the adrenal crisis. Glucocorticoids may have to be continued in the lowest possible dose using a physiological preparation, such as hydrocortisone, when the stoppage is not possible. In this article, we report a 34-year-old male patient with hypopituitarism who developed bilateral AVN while receiving a mild physiological replacement oral prednisolone dose for only three years for secondary adrenal insufficiency of hypopituitarism after transsphenoidal surgery. The patient was switched to hydrocortisone and underwent core decompressive surgery resulting in a reduction of hip pain and improvement. The case report intends to highlight the occurrence of AVN of the femur even with a very low dose of corticosteroid used for the treatment of panhypopituitarism. Avascular necrosis should be considered in the differential diagnosis in patients with hip pain, even in low-dose steroid use because early diagnosis is essential to prevent progression, collapse, and eventually the need for hip replacement in AVN. Bayçınar Medical Publishing 2020-06-18 /pmc/articles/PMC7489177/ /pubmed/32584743 http://dx.doi.org/10.5606/ehc.2020.72773 Text en Copyright © 2020, Turkish Joint Diseases Foundation http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Case Report
Çalapkulu, Murat
Kızılgül, Muhammed
Sencar, Muhammed Erkam
Düğer, Hakan
Uçan, Bekir
Çakal, Erman
Özbek, Mustafa
Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review
title Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review
title_full Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review
title_fullStr Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review
title_full_unstemmed Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review
title_short Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review
title_sort avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: a case report and literature review
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489177/
https://www.ncbi.nlm.nih.gov/pubmed/32584743
http://dx.doi.org/10.5606/ehc.2020.72773
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