Unilateral Femoral Head Osteonecrosis Caused by Low-Dose Oral Corticosteroid Used for Secondary Adrenal Insufficiency From Idiopathic Hypopituitarism

Abstract

Osteonecrosis, commonly known as avascular necrosis (AVN) of bone, is one of the universally recognized side effects of high-dose steroid and commonly involves femur head leading to significant morbidity. But AVN of femur head due to low-dose oral corticosteroid and relatively shorter span of time is a rare occurrence. We report a case of a 41-year-old woman with hypopituitarism who developed right-sided AVN while on a little physiological replacement dose of oral hydrocortisone used only for 7 months for secondary adrenal insufficiency from idiopathic hypopituitarism. Patient was diagnosed with MRI at early stage and managed with lowest possible physiological preparation of hydrocortisone and alendronate and eventually prevented from hip collapse. There should be a high clinical index for patients with any dose of steroid to recognize early, and prevent fracture and ultimately replacement. J Med Cases. 2017;8(7):227-229 doi: https://doi.org/10.14740/jmc2857w