Osteonecrosis of the humeral head under corticosteroid therapy for non-medical reason in a 14-year-old female patient: A case report

Osteonecrosis of the humeral head is a debilitating condition caused by disruption of blood supply to the bone, leading to bone death and potential collapse. Corticosteroid therapy, widely used for its anti-inflammatory effects, is a major risk factor for non-traumatic osteonecrosis, particularly in the shoulder. We present the case of a 14-year-old overweight girl (83 kg, 171 cm, BMI 28.38 kg/m²) admitted for evaluation of a suspected tumor in the upper end of the left humerus, with a history of prolonged corticosteroid use not for medical reasons but aimed at weight gain. Histopathological analysis ruled out malignancy and confirmed osteolysis with inflammatory phenomena. The pathogenesis of corticosteroid-induced osteonecrosis remains debated, with two main theories: fat embolism causing blood flow obstruction and local bone changes including adipocyte accumulation and reduced bone cell differentiation. Early diagnosis, especially with MRI, is crucial for effective management. Conservative treatments are successful in early stages, while surgery is reserved for advanced disease. Corticosteroid therapy remains a significant risk factor for humeral head osteonecrosis, and early diagnosis with appropriate stage-based management is essential to improve patient outcomes.