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Cushing's disease presenting with gastrointestinal perforation: a case report
Takuma Hara1, Hiroyoshi Akutsu1, Tetsuya Yamamoto1
1Department of Neurosurgery, Faculty of Medicine University of Tsukuba 1-1-1 Tennodai Tsukuba Ibaraki, Tsukuba, 305-0006 Japan.
Endocrinology, Diabetes & Metabolism Case Reports
|March 12, 2014
Summary
Gastrointestinal perforation is a rare complication of Cushing's disease, particularly in elderly patients. Early recognition and treatment are crucial for this life-threatening condition associated with hypercortisolism.
Area of Science:
- Endocrinology
- Gastroenterology
- Surgical Oncology
Background:
- Gastrointestinal perforation is a known complication of steroid therapy or hypercortisolism.
- It is rarely observed as a presenting symptom in Cushing's disease.
- Elevated cortisol levels can mask perforation symptoms, delaying diagnosis.
Purpose of the Study:
- To report a rare case of Cushing's disease presenting with gastrointestinal perforation.
- To highlight the association between hypercortisolism and gastrointestinal perforation in elderly patients.
- To discuss treatment strategies for this rare clinical presentation.
Main Methods:
- Case report of a 79-year-old male diagnosed with Cushing's disease and colonic perforation.
- Endocrinological and gastroenterological evaluations were performed.
- Conservative management of perforation followed by endonasal adenomectomy and subsequent colostomy.
Main Results:
- The patient presented with gastrointestinal perforation as a symptom of Cushing's disease.
- Endonasal adenomectomy was performed to normalize cortisol levels.
- A colostomy was successfully performed after adenomectomy.
Conclusions:
- Gastrointestinal perforation should be considered in elderly patients with hypercortisolism, even with masked symptoms.
- Endonasal adenomectomy prior to laparotomy is a viable treatment option for hypercortisolism in cases of conservatively managed perforation.
- Prompt diagnosis and management of gastrointestinal perforation in Cushing's disease are essential.
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