Rheumatic Manifestations of Endocrine Diseases

Joseph A. Markenson


Curr Opin Rheumatol. 2010;22(1):64-71. 

In This Article

Adrenal Disorders

Cushing disease first reported in 1932 by Harvey Cushing described several rheumatic conditions including osteoporosis, avascular necrosis, myopathy and synovitis. Similar findings are also seen in iatrogenic Cushing's secondary to widespread use of exogenous steroids. Mechanisms include inhibition of collagen metabolism as well as decreased availability of calcium reported in several reviews.[68] Avascular necrosis generally appears after long and continued or even discontinued use of corticosteroids. Steroid myopathy often perplexing occurs in patients treated with corticosteroids (many times for myopathy) and presents as extreme weakness and muscle aching often most pronounced in the pelvic girdle. Muscle biopsy demonstrates type 2 fiber atrophy, electromyography shows a myopathic picture, muscle enzymes are not elevated and the condition slowly improves on decreasing or stopping the dose of corticosteroids.[69] A similar picture has been reported in Cushing's disease.[70]

Osteoporosis is related to the dose and duration of disease and recently there have been several treatment regimens reported including the use of calcium, vitamin D (D3) bisphosphonates and PTH.[71••,72••]


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