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Höch A, Pieroh P, Dehghani F, et al. An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing's Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?. Case Rep Orthop. 2016;2016:9250938doi: 10.1155/2016/9250938.
Höch, A., Pieroh, P., Dehghani, F., Josten, C., & Böhme, J. (2016). An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing's Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?. Case reports in orthopedics, 20169250938. https://doi.org/10.1155/2016/9250938
Höch, Andreas, et al. "An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing's Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?." Case reports in orthopedics vol. 2016 (2016): 9250938. doi: https://doi.org/10.1155/2016/9250938
Höch A, Pieroh P, Dehghani F, Josten C, Böhme J. An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing's Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?. Case Rep Orthop. 2016;2016:9250938. doi: 10.1155/2016/9250938. Epub 2016 Jan 20. PMID: 26904337; PMCID: PMC4745920.
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Case Rep Orthop. 2016;2016:9250938. doi: 10.1155/2016/9250938. Epub 2016 Jan 20.

An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing's Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?.

Case reports in orthopedics

Andreas Höch, Philipp Pieroh, Faramarz Dehghani, Christoph Josten, Jörg Böhme

Affiliations

  1. Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
  2. Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany; Department of Anatomy and Cell Biology, Martin Luther University of Halle-Wittenberg, Grosse Steinstrasse 52, 06097 Halle (Saale), Germany.
  3. Department of Anatomy and Cell Biology, Martin Luther University of Halle-Wittenberg, Grosse Steinstrasse 52, 06097 Halle (Saale), Germany.

PMID: 26904337 PMCID: PMC4745920 DOI: 10.1155/2016/9250938

Abstract

Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle. We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilization. Prior to the injury, she received high-dose glucocorticoids for a tentative diagnosis of rheumatoid arthritis over two months. This diagnosis was not confirmed. Other causes leading to the unstable pelvic girdle were excluded by several laboratory and radiological examinations. Elevated basal cortisol and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormone-dependent Cushing's disease. The combination of adrenocorticotropic hormone-dependent Cushing's disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors' knowledge, this case presents the first description of a rotationally unstable pelvic ring fracture involving a predominantly ligamentous insufficiency in the context of combined exogenous and endogenous glucocorticoid elevation.

References

  1. Orthopedics. 1994 Mar;17 (3):285-9 - PubMed
  2. Injury. 1996;27 Suppl 1:S-A13-20 - PubMed
  3. J Orthop Res. 2014 Jul;32(7):873-9 - PubMed
  4. J Orthop Trauma. 1997 May;11(4):273-6 - PubMed
  5. Injury. 2010 Jun;41(6):657-9 - PubMed
  6. Chirurg. 2012 Oct;83(10):875-81 - PubMed
  7. Orthop Rev (Pavia). 2009 Oct 10;1(2):e23 - PubMed
  8. Z Orthop Unfall. 2011 Jan;149(1):83-9 - PubMed
  9. Injury. 2013 Dec;44(12 ):1733-44 - PubMed
  10. Rheum Dis Clin North Am. 2006 Nov;32(4):733-57 - PubMed
  11. Spine J. 2013 Oct;13(10):1321-30 - PubMed
  12. Clin Orthop Relat Res. 1981 Mar-Apr;(155):43-7 - PubMed
  13. Clin Orthop Relat Res. 1987 Feb;(215):105-8 - PubMed
  14. Postgrad Med J. 2000 Oct;76(900):646-50 - PubMed
  15. Arch Osteoporos. 2012;7:209-18 - PubMed
  16. Osteoporos Int. 2012 Sep;23(9):2257-76 - PubMed
  17. Dan Med Bull. 1984 Jun;31(3):187-206 - PubMed
  18. J Orthop Trauma. 2014 Jan;28(1):41-7 - PubMed
  19. J Orthop Res. 2000 May;18(3):462-71 - PubMed
  20. BMJ. 1991 Jul 6;303(6793):56 - PubMed
  21. Eur J Endocrinol. 2002 Jan;146(1):51-6 - PubMed
  22. Pediatr Emerg Care. 2009 Sep;25(9):586-7 - PubMed
  23. J Clin Endocrinol Metab. 2006 May;91(5):1779-84 - PubMed
  24. J Orthop Trauma. 2010 Oct;24(10):610-5 - PubMed
  25. Br J Rheumatol. 1998 Jul;37(7):789-93 - PubMed
  26. J R Soc Med. 1995 Jan;88(1):28-30 - PubMed
  27. Osteoporos Int. 2000;11(5):443-8 - PubMed
  28. Clin Endocrinol (Oxf). 2004 Feb;60(2):264-70 - PubMed
  29. U S Armed Forces Med J. 1957 Jun;8(6):907-12 - PubMed
  30. Clin Orthop Relat Res. 1996 Aug;(329):141-6 - PubMed
  31. Orthopedics. 1995 Mar;18(3):271-4 - PubMed
  32. Injury. 1995 Mar;26(2):75-80 - PubMed
  33. J Bone Joint Surg Br. 1960 Aug;42-B:432-43 - PubMed
  34. Instr Course Lect. 1992;41:293-300 - PubMed
  35. Pituitary. 2004;7(4):249-52 - PubMed
  36. AJR Am J Roentgenol. 1996 Nov;167(5):1205-10 - PubMed
  37. J Bone Miner Metab. 2007;25(5):333-6 - PubMed
  38. Injury. 2003 Jul;34(7):545-9 - PubMed
  39. Clin Orthop Relat Res. 1980 Sep;(151):12-21 - PubMed
  40. Skeletal Radiol. 1995 Nov;24(8):605-7 - PubMed
  41. Clin Biomech (Bristol, Avon). 2012 Nov;27(9):872-8 - PubMed
  42. J Bone Miner Res. 2005 Aug;20(8):1487-94; discussion 1486 - PubMed
  43. J Exp Med Sci. 1965 Sep;9(2):44-8 - PubMed
  44. J Endocrinol Invest. 2008 Apr;31(4):364-70 - PubMed
  45. J Trauma. 2010 Oct;69(4):880-5 - PubMed
  46. J Trauma. 1990 Jul;30(7):848-56 - PubMed
  47. Injury. 2011 Oct;42(10):997-1002 - PubMed
  48. J Bone Joint Surg Br. 1994 Nov;76(6):882-6 - PubMed
  49. J Bone Joint Surg Am. 1998 Jul;80(7):1043-8 - PubMed
  50. Gend Med. 2010 Jun;7(3):218-29 - PubMed
  51. Am J Physiol. 1971 Oct;221(4):1144-50 - PubMed
  52. Injury. 2014 Oct;45(10):1599-603 - PubMed
  53. J Rheumatol. 2008 Nov;35(11):2249-54 - PubMed
  54. Eur Spine J. 2012 Sep;21(9):1769-76 - PubMed
  55. Curr Pharm Des. 2002;8(21):1877-83 - PubMed
  56. Z Orthop Unfall. 2012 Oct;150(5):477-83 - PubMed
  57. JAMA. 1964 Mar 28;187:1001-4 - PubMed

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