抄録
Two months after delivery a forty-year-old woman suddenly had a severe pain in her left hip joint. She had suffered from mild pain there for six years. X-ray revealed rapid a collapse of the head of her left femur, due to avascular necrosis. On admission about two years after the onset of the severe pain, radiolucent zones (Looser zone) appeared in both rami of the pubic bone and the ribs. No other changes were detected in the spine or other sites.
No abnormalities were detected in the blood analysis. Biochemical examination revealed a low value of serum Ca and a slightly high value of urine Ca, but those of serum P, urine InP, Ca2+, PTH, 25-OH D3, 1, 25- (OH) 2D3 and BMC (bone mineral content) were all within normal range.
In an examination of the adrenal gland, the morning value of cortisol was revealed to be abnormally high, but ACTH was normal. As no suppression was observed in the rapid suppression test, Cushing's syndrome was suspected, but could not be confirmed by the standard suppression test (Liddle's method) as the value of urine 17-OHCS decreased to the normal level after administration of 2mg of Dexamethasone for two days. The bilateral adrenal gland was hypertrophic in scintigraphy.
From these facts, we concluded that she had had subclinical hyperadrenalism, and that the pregnancy had temporarily aggravated the hyperadrenal state, which in turn might have given rise to changes in the metabolism of lipid and vitamine D. This may have been the cause of the avascular necrosis of the femoral head and the remodeling of the pubis and the ribs.
