Severe Kyphosis Secondary to Glucocorticoid-Induced Osteoporosis in Adolescent Twins with Congenital Adrenal Hyperplasia - A Case Report and Literature Review

Abstract

Patients with Congenital Adrenal Hyperplasia (CAH) need a life-long treatment with glucocorticoids (GC) which affects bone quality and bone density. We report the clinical cases of twin sisters diagnosed at birth with CAH (simple virilization form). They both received treatment with GC and were diagnosed with severe Hyperkyphosis; they underwent transpedicular vertebral instrumentation, Ponte osteotomies and posterior autograft spinal fusion. Post-surgery evolution was favourable. After 3 years, one of the patients suffered a spinal implant infection that needed debridement and drainage. Patients with long term treatment with GC have a higher risk for osteoporosis than the general population. While monitoring the patients we should take into consideration the bone`s status and preventive measures against osteoporosis. It is important to diagnose the deformities of the spine at a young age in order to be able to tray a conservative treatment because, for these patients, surgery comes with a higher risk of complications. It is necessary to have paediatric orthopaedic checkups for children with long term GC treatment.