Hara Takuma, Akutsu Hiroyoshi, Yamamoto Tetsuya, Ishikawa Eiichi, Matsuda Masahide, Matsumura Akira
Department of Neurosurgery, Faculty of Medicine University of Tsukuba 1-1-1 Tennodai Tsukuba Ibaraki, Tsukuba, 305-0006 Japan.
Endocrinol Diabetes Metab Case Rep. 2013;2013:130064. doi: 10.1530/EDM-13-0064. Epub 2013 Nov 18.
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.
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.
胃肠道穿孔是与类固醇治疗或皮质醇增多症相关的一种并发症，但在库欣病患者的临床实践中很少观察到，仅有一例被报道为首发症状。在此，我们报告一例罕见的库欣病病例，该患者以胃肠道穿孔为症状。一名79岁男性主诉下腹部不适6个月。基于内分泌和胃肠检查，他被诊断为库欣病伴降结肠穿孔。在与胃肠外科医生会诊后，由于全身炎症较轻且无腹部压痛，决定对结肠穿孔可在不进食的情况下进行保守观察，并给予静脉注射抗生素治疗。尽管血清皮质醇水平显著升高，但由于结肠穿孔，口服药物不是一个选择。因此，该患者接受了经鼻腺瘤切除术以使血清皮质醇水平正常化。随后，成功进行了结肠造口术。尽管这种情况罕见，但医生应意识到胃肠道穿孔可能与皮质醇增多症有关，尤其是在老年患者中，对这种危及生命的情况进行及时诊断和治疗至关重要。如果穿孔可以保守观察，在剖腹手术前进行经鼻腺瘤切除术是治疗皮质醇增多症的一种替代治疗选择。
迄今为止，仅有一例胃肠道穿孔作为库欣病的首发临床症状被报道。医生应意识到胃肠道穿孔可能与老年患者的皮质醇增多症有关，因为血清皮质醇水平升高可能掩盖穿孔的临床体征。由于这种掩盖作用，穿孔的诊断也往往会延迟。尽管静脉注射依托咪酯是降低血清皮质醇升高水平的标准治疗选择，但如果无法进行依托咪酯治疗，在剖腹手术前进行经鼻腺瘤切除术是一种替代治疗选择。
