Multiple pathologic fractures of the appendicular skeleton in a patient with Cushing's disease.

A 33-year-old woman with asymptomatic osteoporosis sustained a spontaneous middiaphyseal fracture of the femur as the initial sign of Cushing's disease. Subsequently, she incurred a fracture of the ipsilateral hip and both bones of the forearm. All four fractures failed to unite. There were no symptoms of involvement of the axial skeleton. Although axial osteopenia is the most common skeletal finding in hypercortisolism, fractures exclusively limited to the appendicular skeleton should not preclude detailed diagnostic investigations of hypercortisolism.