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Cushing's disease presenting with gastrointestinal perforation: a case report

Gastrointestinal perforation is a complication associated with steroid therapy or hypercortisolism, but it is rarely observed in patients with Cushing's disease in clinical practice, and only one case has been reported as a presenting symptom. Herein, we report a rare case of Cushing's dis...

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Autores principales: Hara, Takuma, Akutsu, Hiroyoshi, Yamamoto, Tetsuya, Ishikawa, Eiichi, Matsuda, Masahide, Matsumura, Akira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922247/
https://www.ncbi.nlm.nih.gov/pubmed/24616779
http://dx.doi.org/10.1530/EDM-13-0064
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author Hara, Takuma
Akutsu, Hiroyoshi
Yamamoto, Tetsuya
Ishikawa, Eiichi
Matsuda, Masahide
Matsumura, Akira
author_facet Hara, Takuma
Akutsu, Hiroyoshi
Yamamoto, Tetsuya
Ishikawa, Eiichi
Matsuda, Masahide
Matsumura, Akira
author_sort Hara, Takuma
collection PubMed
description Gastrointestinal perforation is a complication associated with steroid therapy or hypercortisolism, but it is rarely observed in patients with Cushing's disease in clinical practice, and only one case has been reported as a presenting symptom. Herein, we report a rare case of Cushing's disease in which a patient presented with gastrointestinal perforation as a symptom. A 79-year-old man complained of discomfort in the lower abdomen for 6 months. Based on the endocrinological and gastroenterological examinations, he was diagnosed with Cushing's disease with a perforation of the descending colon. After consultation with a gastroenterological surgeon, it was decided that colonic perforation could be conservatively observed without any oral intake and treated with parenteral administration of antibiotics because of the mild systemic inflammation and lack of abdominal guarding. Despite the marked elevated levels of serum cortisol, oral medication was not an option because of colonic perforation. Therefore, the patient was submitted to endonasal adenomectomy to normalize the levels of serum cortisol. Subsequently, a colostomy was successfully performed. Despite its rarity, physicians should be aware that gastrointestinal perforation may be associated with hypercortisolism, especially in elderly patients, and immediate diagnosis and treatment of this life-threatening condition are essential. If a perforation can be conservatively observed, endonasal adenomectomy prior to laparotomy is an alternative treatment option for hypercortisolism. LEARNING POINTS: Thus far, only one case of gastrointestinal perforation as a presenting clinical symptom of Cushing's disease has been reported. Physicians should be aware that gastrointestinal perforation might be associated with hypercortisolism in elderly patients because elevated levels of serum cortisol may mask the clinical signs of perforation. Because of this masking effect, the diagnosis of the perforation also tends to be delayed. Although parenteral administration of etomidate is a standard treatment option for decreasing the elevated levels of serum cortisol, endonasal adenomectomy prior to laparotomy is an alternative treatment option if etomidate therapy is unavailable.
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spelling pubmed-39222472014-03-10 Cushing's disease presenting with gastrointestinal perforation: a case report Hara, Takuma Akutsu, Hiroyoshi Yamamoto, Tetsuya Ishikawa, Eiichi Matsuda, Masahide Matsumura, Akira Endocrinol Diabetes Metab Case Rep Unique/Unexpected Symptoms or Presentations of a Disease Gastrointestinal perforation is a complication associated with steroid therapy or hypercortisolism, but it is rarely observed in patients with Cushing's disease in clinical practice, and only one case has been reported as a presenting symptom. Herein, we report a rare case of Cushing's disease in which a patient presented with gastrointestinal perforation as a symptom. A 79-year-old man complained of discomfort in the lower abdomen for 6 months. Based on the endocrinological and gastroenterological examinations, he was diagnosed with Cushing's disease with a perforation of the descending colon. After consultation with a gastroenterological surgeon, it was decided that colonic perforation could be conservatively observed without any oral intake and treated with parenteral administration of antibiotics because of the mild systemic inflammation and lack of abdominal guarding. Despite the marked elevated levels of serum cortisol, oral medication was not an option because of colonic perforation. Therefore, the patient was submitted to endonasal adenomectomy to normalize the levels of serum cortisol. Subsequently, a colostomy was successfully performed. Despite its rarity, physicians should be aware that gastrointestinal perforation may be associated with hypercortisolism, especially in elderly patients, and immediate diagnosis and treatment of this life-threatening condition are essential. If a perforation can be conservatively observed, endonasal adenomectomy prior to laparotomy is an alternative treatment option for hypercortisolism. LEARNING POINTS: Thus far, only one case of gastrointestinal perforation as a presenting clinical symptom of Cushing's disease has been reported. Physicians should be aware that gastrointestinal perforation might be associated with hypercortisolism in elderly patients because elevated levels of serum cortisol may mask the clinical signs of perforation. Because of this masking effect, the diagnosis of the perforation also tends to be delayed. Although parenteral administration of etomidate is a standard treatment option for decreasing the elevated levels of serum cortisol, endonasal adenomectomy prior to laparotomy is an alternative treatment option if etomidate therapy is unavailable. Bioscientifica Ltd 2013-11-18 2013 /pmc/articles/PMC3922247/ /pubmed/24616779 http://dx.doi.org/10.1530/EDM-13-0064 Text en © 2013 The authors This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by/3.0/deed.en_GB) .
spellingShingle Unique/Unexpected Symptoms or Presentations of a Disease
Hara, Takuma
Akutsu, Hiroyoshi
Yamamoto, Tetsuya
Ishikawa, Eiichi
Matsuda, Masahide
Matsumura, Akira
Cushing's disease presenting with gastrointestinal perforation: a case report
title Cushing's disease presenting with gastrointestinal perforation: a case report
title_full Cushing's disease presenting with gastrointestinal perforation: a case report
title_fullStr Cushing's disease presenting with gastrointestinal perforation: a case report
title_full_unstemmed Cushing's disease presenting with gastrointestinal perforation: a case report
title_short Cushing's disease presenting with gastrointestinal perforation: a case report
title_sort cushing's disease presenting with gastrointestinal perforation: a case report
topic Unique/Unexpected Symptoms or Presentations of a Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922247/
https://www.ncbi.nlm.nih.gov/pubmed/24616779
http://dx.doi.org/10.1530/EDM-13-0064
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