symptomatic adrenal adenoma usually presents with systemic symptoms . depending on the function of the adenoma , the patient can present with pheochromocytoma - like symptoms ; primary hyperaldosteronism and cushing syndrome ( weight gain , weakness , depression , and bruising ) .
a 41 year - old lady presented with multiple metatarsal and phalangeal fractures of the both feet without significant injury .
laproscopic r adrenalectomy was performed and histological study confirmed adrenal cortical adenoma with adjacent cortical atrophy suggestive of a functioning adenoma .
symptomatic adrenal adenoma usually presents with systemic symptoms . depending on the function of the adenoma , the patient can present with pheochromocytoma - like symptoms ( palpitations , sweating , headache , abdominal pain and labile hypertension ) ; primary hyperaldosteronism ( hypertension and unprovoked hypokalemia ) and cushing syndrome ( weight gain , weakness , depression , and bruising ) .
we reported a case of bilateral adrenal adenoma who presented with multiple insufficiency fracture of both feet .
a 41 year - old lady presented to us with fracture of the base of her left fifth metatarsal after an inversion sprain ( fig 1 ) .
she had sudden onset of left forefoot pain eight months later without any preceding injury .
radiographs showed fracture of her left second metatarsal with callus formation ( fig 2 ) .
radiographs showed old fractures of bases of bilateral fifth metatarsals , proximal phalanges of bilateral third toes , left second metatarsal with callus formation and crack fracture of the proximal phalanx of the left fourth toe ( fig 3 ) .
she was newly diagnosed to have diabetes mellitus but the sensation of the feet was still intact .
overnight dexamethasone suppression test ( ondst ) was 660nmol / l which was non suppressible .
the serum cortisol reached peak level of 699 in low dose short synacthen test ( ldsst ) and the acth level was less than 1.6 .
computed tomogram showed bilateral adrenal adenoma ( fig 4 ) . in order to plan for surgery , the functionality of the adenomas needed to be determined .
radiographs showed old fractures of bases of bilateral fifth metatarsals , proximal phalanges of bilateral third toes , left second metatarsal with callus formation and crack fracture of the proximal phalanx of the left fourth toe .
multiple metatarsal and phalangeal fractures of the foot of different ages without any significant injury are uncommon .
this lady is a housewife and not involved in any activity that can contribute to fatigue fracture .
dexa scan was performed as insufficiency fracture was suspected   and the result confirmed the presence of osteoporosis .
overnight dexamethasone suppression test ( ondst ) , urine cortisol level , low dose short synacthen test ( ldsst ) and the acth level was compatible with adrenal cushing syndrome . adrenal adenoma is a cause of cushing syndrome that is surgically treatable .
the presence of adenoma in both adrenal glands needs further study of the functionality of the tumours for surgical planning .
histological study confirmed adrenal cortical adenoma with adjacent cortical atrophy suggestive of a functioning adenoma .
the clinical significance of this report is that it demonstrates the multiple phalangeal and metatarsal fractures can be the sole presentation of adrenal adenoma .
causes of secondary osteoporosis should be investigated in pre - menopausal patient with insufficiency fracture of the feet .
 introduction : symptomatic adrenal adenoma usually presents with systemic symptoms . depending on the function of the adenoma , the patient can present with pheochromocytoma - like symptoms ; primary hyperaldosteronism and cushing syndrome ( weight gain , weakness , depression , and bruising).case report : a 41 year - old lady presented with multiple metatarsal and phalangeal fractures of the both feet without significant injury . 
 dexa scan showed evidence of osteoporosis . 
 investigations showed that the picture was compatible with adrenal cushing syndrome . 
 computed tomogram showed bilateral adrenal adenoma . 
 adrenal cortex scintigraphy with np-59 scan showed hyperfunctioning right adrenal adenoma . 
 laproscopic r adrenalectomy was performed and histological study confirmed adrenal cortical adenoma with adjacent cortical atrophy suggestive of a functioning adenoma . 
 post - operatively , she was put on hydrocortisone replacement and recovered well.conclusion:adrenal adenoma can present with insufficiency fractures of the feet . 