Cushing's disease presenting with avascular necrosis of the hip: An orthopedic emergency

Nontraumatic avascular necrosis (AVN) of the hip is commonly caused by exog enous glucocorticoid administration, whereas it has rarely been associated with endogenous hypercortisolism. We report a 30-yr-old woman with Gushing' s disease whose presenting manifestation was early AVN of the hip. Although plain x-ray was negative, magnetic resonance imaging (MRI) of the hip show ed stage 2 AVN. Her orthopedic disease was considered an emergency, and thu s, it was treated with core decompression before the diagnosis of Gushing's syndrome (CS) was pursued further. The femur recovered fully, as demonstra ted by her improved clinical picture and a subsequent MRI. AVN carries a po or prognosis, if not treated early. The diagnostic procedure of choice is M RI, because plain radiographs are falsely negative in early stages. This ca se illustrates that AVN can be the presenting manifestation of CS; to preve nt irreversible effects on the femoral head, core decompression should not be delayed. for the purpose of evaluation and treatment of CS.