Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review
Year: 2020
Type: article
Study design: Case Report
Abstract: Glucocorticoidsare drugs that exhibit immunosuppressive and antiinflammatory effects at appropriate therapeutic doses.Many side effects are encountered during glucocorticoid treatment.Osteoporosis is a common side effect on bone metabolism, while avascular necrosis (AVN) is a rare side effect.[1] The causes of AVN include interruption of the vascular supply as a result of local trauma or non-traumatic systemic conditions.Non-traumatic systemic conditions associated with AVN include corticosteroid administration, fat emboli, hemoglobinopathies (e.g., sickle cell anemia), systemic lupus erythematosus, and alcoholism.[2] Avascular necrosis is also known as aseptic necrosis or osteonecrosis, which occurs in approximately 3-40% of patients receiving corticosteroids.The most common site of involvement is the femoral head, which may lead to severe morbidity.[2] The risk of glucocorticoid-induced osteonecrosis is associated with the dose and the duration of glucocorticoid use.[3,4] In most cases, AVN is a result of high doses of steroids given for a long period of time, and 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.
Author: Murat Çalapkulu
Language: English
Topic: Bone and Joint Diseases
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W3038104363