DOI QR코드

DOI QR Code

Leg Weakness in a Patient with Lumbar Stenosis and Adrenal Insufficiency

  • Kim, Kyoung-Tae (Department of Neurosurgery, Kyungpook National University, Hospital) ;
  • Ahn, Suk-Won (Department of Neurology, College of Medicine, Chung-Ang University) ;
  • Kwon, Jeong-Taik (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Kim, Young-Baeg (Department of Neurosurgery, College of Medicine, Chung-Ang University)
  • Received : 2010.06.23
  • Accepted : 2011.03.27
  • Published : 2011.04.28

Abstract

Lumbar spinal stenosis (LSS) is a common spinal disease in the elderly. The cardinal symptom of LSS is neurogenic claudication, but not all patients present with such typical symptom. The clinical symptoms are often confused with symptoms of peripheral neuropathy, musculo-skeletal disease and other medical conditions in elderly patients. In particular, LSS presenting with rapid progression of leg weakness must be distinguished from other combined diseases. We report a case of rapid progressive leg weakness in a patient with LSS and iatrogenic adrenal insufficiency that was induced by obscure health supplement.

Keywords

References

  1. Arafah BM : Hypothalamic pituitary adrenal function during critical illness: limitations of current assessment methods. J Clin Endocrinol Metab 91 : 3725-3745, 2006 https://doi.org/10.1210/jc.2006-0674
  2. Bornstein SR : Predisposing factors for adrenal insufficiency. N Engl J Med 360 : 2328-2339, 2009 https://doi.org/10.1056/NEJMra0804635
  3. Coursin DB, Wood KE : Corticosteroid supplementation for adrenal insufficiency. JAMA 287 : 236-240, 2002 https://doi.org/10.1001/jama.287.2.236
  4. Egli D, Hausmann O, Schmid M, Boos N, Dietz V, Curt A : Lumbar spinal stenosis: assessment of cauda equina involvement by electrophysiological recordings. J Neurol 254 : 741-750, 2007 https://doi.org/10.1007/s00415-006-0427-1
  5. Fraser CG, Preuss FS, Bigford WD : Adrenal atrophy and irreversible shock associated with cortisone therapy. J Am Med Assoc 149 : 1542-1543, 1952 https://doi.org/10.1001/jama.1952.72930340001009
  6. Ghanayem AJ : Clinical presentation and diagnosis, in Frymoyer JW WS (ed) : The adult & pediatric spine, ed 3. Philadelphia : Lippincott Williams & Wilkins, 2004, pp955-957
  7. Jabbour SA : Steroids and the surgical patient. Med Clin North Am 85 : 1311-1317, 2001 https://doi.org/10.1016/S0025-7125(05)70379-5
  8. Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH : Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 21 : 92-98, 1996 https://doi.org/10.1097/00007632-199601010-00022
  9. Khosla S, Lufkin EG, Hodgson SF, Fitzpatrick LA, Melton LJ 3rd : Epidemiology and clinical features of osteoporosis in young individuals. Bone 15 : 551-555, 1994 https://doi.org/10.1016/8756-3282(94)90280-1
  10. Lewis L, Robinson RF, Yee J, Hacker LA, Eisen G : Fatal adrenal cortical insufficiency precipitated by surgery during prolonged continuous cortisone treatment. Ann Intern Med 39 : 116-126, 1953 https://doi.org/10.7326/0003-4819-39-1-116
  11. Porter RW : Spinal stenosis and neurogenic claudication. Spine (Phila Pa 1976) 21 : 2046-2052, 1996 https://doi.org/10.1097/00007632-199609010-00024
  12. Reynolds RM, Dennison EM, Walker BR, Syddall HE, Wood PJ, Andrew R, et al. : Cortisol secretion and rate of bone loss in a population-based cohort of elderly men and women. Calcif Tissue Int 77 : 134-138, 2005 https://doi.org/10.1007/s00223-004-0270-2
  13. Verbiest H : A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br 36B : 230-237, 1954