BILATERAL FEMORAL FRACTURE IN A YOUNG FILIPINO FEMALE WITH PROBABLE AUTOIMMUNE POLYENDOCRINE SYNDROME TYPE 4

Abstract

CASE
Autoimmune polyendocrine syndrome (APS) type 4 is a clustering of at least two or more endocrine diseases which do not fall into other APS categories. A 35-year-old Filipino female with a height of 127 cm sustained bilateral distal femoral pathologic fractures from a low-impact fall. She underwent bilateral minimally invasive plate osteosynthesis. Secondary osteoporosis was attributed to chronic steroid use (prednisone 10 mg for 24 months) for rheumatoid arthritis, premature ovarian failure at 20 years of age without hormone replacement therapy and persistently elevated TSH amid high-dose levothyroxine (4.25 µg/kg/day). A consideration of celiac disease was also made. APS is a rare complex syndrome which may lead to various complications. The presence of hypogonadism, hypothyroidism, celiac disease, rheumatoid arthritis, inadequately treated hypothyroidism and chronic steroid use further increased the risk for secondary osteoporosis. Early screening and treatment would have prevented the occurrence of pathologic fractures.