Introduction: Cushing’s syndrome (CS) is an important cause of secondary osteoporosis. Association of ovarian cancer and surgically induced menopause leads to further bone loss.
Case report: A 59-year old female patient, known with left breast fibroadenoma, ovarian adeno-carcinoma, and early surgical menopause consequence of bilateral oophorectomy, was admitted for CS features including lumbar pain, muscle weakness, etc. Hormonal specific tests and abdominal computed tomography scan confirmed CS related to a left adrenal adenoma. Secondary osteoporosis was highlighted at Dual-Energy X-Ray Absorptiometry (DXA) without anomalies at whole body bone scintigraphy and profile X-ray. Vitamin D deficiency without secondary hyperparathyroidism and normal thyroid function tests were founded. Laparoscopic left adrenalectomy was performed and weekly oral alendronic acid together with daily vitamin D and calcium supplements were offered to the patient. Close endocrine, oncologic and imagery check-up is recommended.
Conclusion: Surgical menopause for ovarian cancer in association with anti-estrogen therapy in young females is a contributor to later diagnosis of osteoporosis. A second tumor, though benign, may accelerate the bone loss due to endocrine anomalies as adrenal tumor related hypercorticism. The CS confirmation of a patient with ovarian cancer may indicate an ectopic source of ACTH which was not the case here.
Abbreviations: mg = milligram, cm = centimeter, ACTH = Adrenocorticotropic Hormone, BMD = bone mineral density, CS = Cushing’s syndrome, DXM = dexamethasone, FT4 = Free Thyroxine, iPTH = intact Parathormone
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