Abstract
Case Presentation: A 47-year-old male presented for worsening osteopenia on long-term glucocorticoids. Past history was significant for pulmonary sarcoidosis on prednisone 10 mg daily for 4 years, as well as a seizure disorder. A dual-energy X-ray absorptiometry (DXA) scan 2 years after steroid initiation showed osteopenia and as a result the patient was started on alendronate. Repeat DXA 2 years later showed worsening osteopenia for which he was referred to the endocrine clinic. Physical exam was notable for a short stature measuring at 63 inches, brachydactyly of the fourth and fifth hand digits, and absent fourth and fifth knuckles (Figs. 1 and 2). Radiography confirmed shortening of the left fourth and fifth metacarpals and of the right fifth metacarpal (Fig. 3). The patient had normal serum calcium and normal parathyroid hormone (PTH). What is the diagnosis? Fig. 2 View Large Image Figure Viewer Fig. 3 View Large Image Figure Viewer
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