RESUMO
A 28-year-old woman underwent bone scintigraphy for a 7-day history of severe back pain of sudden onset. Intense linear accumulation of Tc-99m HDP was present in several lower thoracic and lumbar vertebrae without vertebral body deformity. Intense uptake was also present in other thoracic vertebrae with vertebral body changes. X-rays demonstrated osteopenia and dual photon densitometry studies confirmed a significant degree of osteoporosis. Endocrine assessment identified that she and other female members of the family had osteogenesis imperfecta, Sillence type 1. This disorder should be considered in all differential diagnoses of nonobvious traumatic fractures of the vertebrae in healthy young adults.
Assuntos
Fraturas Espontâneas/etiologia , Vértebras Lombares/lesões , Osteogênese Imperfeita/complicações , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/lesões , Adulto , Feminino , Fraturas Espontâneas/diagnóstico , Humanos , Osteogênese Imperfeita/genética , Fraturas da Coluna Vertebral/diagnósticoRESUMO
We investigated the effect of growth hormone (GH) treatment on mineral and vitamin D homeostasis, bone mineralisation, and body composition in short-statured children without GH deficiency (GHD). 11 children received GH (0.50 +/- 0.08 IU/kg/week) for 24 weeks. 1,25-Dihydroxyvitamin D3 levels (mean +/- SD in pmol/l) rose from a baseline of 73.7 +/- 39.2 to 114.0 +/- 32.7 at 8 weeks (p < 0.05) and 111.9 +/- 39.7 at 24 weeks (p < 0.01). Body composition evaluation using dual-energy X-ray absorptiometry revealed increased lean tissue mass and a reduction in fat tissue. As a percentage of total body mass, fat decreased from 19.0 +/- 11.8% at baseline to 17.3 +/- 11.5% at 8 weeks (p < 0.005) and 16.8 +/- 11.5% at 24 weeks (p < 0.05). L2-L4 bone mineral density was 0.637 +/- 0.155 g/cm2 at baseline and 0.666 +/- 0.160 g/cm2 at 24 weeks (NS). We conclude that recombinant human GH treatment of short children without GHD has significant effects on vitamin D homeostasis and body composition.
Assuntos
Composição Corporal/efeitos dos fármacos , Calcificação Fisiológica/efeitos dos fármacos , Cálcio/metabolismo , Transtornos do Crescimento/tratamento farmacológico , Hormônio do Crescimento/farmacologia , Homeostase/efeitos dos fármacos , Calcitriol/sangue , Criança , Feminino , Hormônio do Crescimento/efeitos adversos , Hormônio do Crescimento/uso terapêutico , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Estudos Prospectivos , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/farmacologia , Proteínas Recombinantes/uso terapêuticoRESUMO
A case of Cushing's disease presenting with avascular necrosis of the femoral heads is described. Eighteen months after the onset of hip symptoms the patient developed pituitary apoplexy and presented to hospital as a medical emergency. Endogenous hypercortisolism is a rare and important cause of avascular necrosis of bone.