Endocrine Case Report: Hip Pain

History of Present Illness:

A 40-ish-year-old male with a history of type 1 diabetes presents to the emergency department for 2 weeks of waxing and waning right groin & inner thigh pain that is aggravated by activity. Even at rest it is bad and he cannot sleep due to the pain.He even started using a cane for the first time in his life. He has had chills but denies any fever, injury or other complaint. He has no other past medical history and denies drug use.

Vital Signs & Physical Exam:

Vital signs are normal except for a temperature of 99.3. Physical exam is normal except for limping and pain with forced internal rotation of the hip.

Initial Diagnostic Testing:

UA: Shows hematuria without pyuria

CBC: WBC = 9.4, Hb = 12.9, plt = 519. CRP moderately elevated

BMP: glucose 316, sodium 131. Everything else normal. No anion gap

Imaging: See ultrasound below

Credit: Brady Pregerson