Cortisone associated diverticular perforation

Goethals, Laurence

doi:10.5334/jbr-btr.705

Cited by 5 publications

(9 citation statements)

References 11 publications

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“…The association between diverticular perforation and hypercortisolism is still controversial. However, there are several reports of oral steroid therapy leading to gastrointestinal perforation (4) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) . Excessive levels of steroids may cause gastrointestinal perforation by thinning the bowel lymphoid tissue, thereby diminishing resistance to bacterial invasion, slowing down the turnover of intestinal mucosal cells, and decreasing fibroblastic reparative activity (25) .…”

Section: Discussionmentioning

confidence: 99%

“…Gastrointestinal perforation may also result from an increased vulnerability of the tissue, which in turn results from the increased secretion of glucocorticoids, a symptom of Cushing's disease (4) (8) (9) . Elderly patients generally tend to experience increased tissue vulnerability.…”

Section: Discussionmentioning

confidence: 99%

“…Direct associations between hypercortisolism and diverticular perforation are extremely rare, but an indirect association (i.e. masking effect of hypercortisolism) has been suggested (4) (26) . In the case reported herein, the diagnosis of gastrointestinal perforation was complicated because of the masking of the inflammatory response by an elevated level of cortisol.…”

Section: Discussionmentioning

confidence: 99%

“…The risk of perforation increases in the elderly and oral steroid users. Colonic diverticula and long-term hypercortisolism resulting from oral steroid therapy affect the development of gastrointestinal perforation (4) (5) (6) (7) (8) (9) . The prevalence of colonic diverticula increases with age.…”

Section: Discussionmentioning

confidence: 99%

“…Cushing's disease accounts for 4.7% of pituitary adenomas (1) , and typically patients show clinical symptoms of impaired glucose tolerance, hypertension, central obesity, moon face, osteoporosis, and psychosis (2) (3) . Gastric/duodenal ulcers may also present as clinical symptoms in hypercortisolism patients undergoing steroid therapy (4) (5) (6) (7) (8) (9) , but are rarely observed in clinical practice; thus far, only one case of a patient with Cushing's disease presenting with gastrointestinal perforation has been reported (10) . Herein, we report a rare case of Cushing's disease in which colonic perforation was a presenting symptom.…”

Section: Introductionmentioning

confidence: 99%

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

Hara¹,

Akutsu²,

Yamamoto³

et al. 2013

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Hara¹,

Akutsu²,

Yamamoto³

et al. 2013

Endocrinology, Diabetes &Amp; Metabolism Case Reports

View full text Add to dashboard Cite

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A Case of Abdominal Perforation in a COVID+ Patient Treated With Tocilizumab and Corticosteroids

Chaudhry

Alekseyev²,

Didenko³

et al. 2023

Clin Med Insights Case Rep

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Coronavirus Disease 2019 (COVID-19) was first identified in Wuhan province in China in late 2019. Around 15% of patients that develop severe acute respiratory syndrome from COVID-19 also develop severe COVID-19 pneumonia. Since the pandemic’s start, various treatments including remdesivir, dexamethasone, baricitinib, convalescent plasma, and tocilizumab have been approved by the Center for Disease Control (CDC). We present a case of a 62-year-old male hospitalized due to COVID-19 pneumonia and was initially treated with methylprednisolone and remdesivir, and later with tocilizumab. Soon after, he developed an abdominal perforation which was surgically treated. In terms of abdominal perforation, proposed mechanisms including the pathogenesis due to the presence of specific angiotensin-converting enzyme 2 (ACE-2) receptors located throughout the gastrointestinal tract, glucocorticoid steroid inflammatory suppression, in addition to the documented adverse effects from tocilizumab which has been previously reported. In summary, tocilizumab may increase the risk of abdominal perforation, especially when used in combination with steroids to treat COVID-19 because steroids may suppress clinical exam findings for abdominal perforation.

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Bowel perforation associated with Cushing’s disease: a case report with literature review

Ishinoda,

Uto,

Meshino

et al. 2023

Endocr J

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Although rare, endogenous hypercortisolemia, including Cushing's disease (CD), is known to cause bowel perforation and to mask typical symptoms of bowel perforation, leading to delayed diagnosis. Additionally, elderly patients with CD are considered to be at a higher risk for bowel perforation because intestinal tissue fragility tends to increase in the elderly. Herein, we describe a rare case in which a young adult patient with CD was diagnosed with bowel perforation associated with CD following severe abdominal pain. A 24-year-old Japanese man was admitted to the hospital for the evaluation of ACTH-dependent Cushing's syndrome. He suddenly complained of severe abdominal pain on the 8th day of hospitalization. Computed tomography revealed free air around the sigmoid colon. The patient was diagnosed with bowel perforation, underwent emergency surgery, and was saved. He was subsequently diagnosed with CD, and the pituitary adenoma was resected transsphenoidally. To date, eight cases of bowel perforation due to CD had been reported, with a median age of 61 years at the time of bowel perforation. Hypokalemia was detected in half of the patients, and all had a history of diverticular disease. Nevertheless, not many patients complained of peritoneal irritation. In conclusion, this is the youngest reported case with bowel perforation due to CD and the first report of bowel perforation in a patient without a history of diverticular disease. Bowel perforation may occur in patients with CD, irrespective of age and the presence of hypokalemia, diverticular disease, or peritoneal irritation.

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Cortisone associated diverticular perforation

Cited by 5 publications

References 11 publications

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

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

A Case of Abdominal Perforation in a COVID+ Patient Treated With Tocilizumab and Corticosteroids

Bowel perforation associated with Cushing’s disease: a case report with literature review

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