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Aladwani MM, Alrubaiaan MT, Alrayani YH, Alabdali TN. Adrenocorticotropic Hormone-Dependent Cushing's Syndrome Complicated With Gastric Ulcer Perforation in a 30-Year-Old Saudi Female: A Case Report and a Review of the Literature. Cureus 2023; 15:e48089. [PMID: 38046760 PMCID: PMC10690111 DOI: 10.7759/cureus.48089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Gastrointestinal perforation is a well-addressed complication of exogenous hypercortisolism; however, patients with endogenous Cushing's syndrome (CS) do not usually experience this condition in clinical practice. The literature on this subject is limited and consists solely of clinical case reports/series with only 23 instances of gastrointestinal perforation occurring in individuals with endogenous Cushing's syndrome. This is mainly attributed to the rarity of Cushing's syndrome itself and the low chance of occurrence of such complications. We report a case of a recently diagnosed adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome in a 30-years-old female who presented initially with a three-month history of progressive weight gain, generalized weakness, acne, menstrual irregularity, and severe hypokalemia, and then developed a gastric ulcer perforation only one month after her ACTH-dependent Cushing's syndrome diagnosis and was managed through emergent surgery.
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Affiliation(s)
| | - Mishari T Alrubaiaan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Yazeed H Alrayani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Tareq N Alabdali
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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2
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Ishinoda Y, Uto A, Meshino H, Kobayashi A, Okazaki M, Asada H, Wakamatsu S, Tsuda H, Yamada Y, Kasuga A, Oshima N. Bowel perforation associated with Cushing's disease: a case report with literature review. Endocr J 2023; 70:933-939. [PMID: 37380447 DOI: 10.1507/endocrj.ej23-0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
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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Affiliation(s)
- Yuki Ishinoda
- Department of Nephrology and Endocrinology, National Defense Medical College, Saitama 359-8513, Japan
| | - Asuka Uto
- Department of Nephrology and Endocrinology, National Defense Medical College, Saitama 359-8513, Japan
| | - Hitomi Meshino
- Department of Nephrology and Endocrinology, National Defense Medical College, Saitama 359-8513, Japan
| | - Ai Kobayashi
- Department of Nephrology and Endocrinology, National Defense Medical College, Saitama 359-8513, Japan
| | - Maki Okazaki
- Department of Nephrology and Endocrinology, National Defense Medical College, Saitama 359-8513, Japan
| | - Hidetomo Asada
- Department of Nephrology and Endocrinology, National Defense Medical College, Saitama 359-8513, Japan
| | - Seina Wakamatsu
- Department of Nephrology and Endocrinology, National Defense Medical College, Saitama 359-8513, Japan
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, Saitama 359-8513, Japan
| | - Yoshifumi Yamada
- Department of Nephrology and Endocrinology, National Defense Medical College, Saitama 359-8513, Japan
| | - Akira Kasuga
- Department of Nephrology and Endocrinology, National Defense Medical College, Saitama 359-8513, Japan
| | - Naoki Oshima
- Department of Nephrology and Endocrinology, National Defense Medical College, Saitama 359-8513, Japan
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3
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ACTH-secreting parotid acinic cell carcinoma unusually reported as a paraneoplastic syndrome. Endocr Regul 2022; 56:163-167. [DOI: 10.2478/enr-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Paraneoplastic syndromes, induced by an immunological cross-reaction or hormone/peptide secretion, are an atypical presentation of tumors. Some tumors, such as small cell lung cancer and bronchial carcinoid, can be adrenocorticotropic hormone (ACTH) secreting tumors. Less commonly, parotid acinic cell carcinoma can be ACTH-secreting tumor leading to Cushing’s syndrome. Few literature cases have described ACTH related paraneoplastic syndrome of parotid adenocarcinoma. Because of the rarity of the condition, little is known about the management and prognosis of this phenomenon. In this report, we highlighted the case of a 59-year-old male with a past medical history of parotid adenocarcinoma treated with surgery, chemotherapy, and radiation therapy presented with clinical and biochemical signs of hyperaldosteronism. Abdominal ultra-sound, computed tomography, and magnetic resonance imaging showed hepatic mass. Liver biopsy with immunohistochemistry confirmed the presence of parotid adenocarcinoma secreting ACTH. He is on paclitaxel and carboplatin medication with good clinical response.
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Wade L, Kitching P, De Winton E. Ectopic ACTH Secretion Secondary to Metastatic Acinic Cell Carcinoma of the Parotid Gland: A Case Report and Review of Current Evidence for Systemic Therapy. J Investig Med High Impact Case Rep 2021; 8:2324709620918080. [PMID: 32410474 PMCID: PMC7232044 DOI: 10.1177/2324709620918080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Acinic cell carcinoma is a rare, typically indolent, neoplasm that arises in the
salivary glands. Metastatic disease is uncommon, occurring in around 10% of
cases. We report the case of a 46-year-old male in whom the first sign of
disseminated disease was increased skin pigmentation due to paraneoplastic
Cushing’s syndrome. He underwent 3 cycles of chemotherapy with carboplatin and
paclitaxel with no symptomatic improvement and a mixed response on imaging.
There is no evidence that systemic therapy prolongs survival in metastatic
acinic cell carcinoma, and we lack a consensus as to which treatment options are
most beneficial. A summary of published evidence regarding choice of palliative
chemotherapy regimens and response is discussed in relation to the case.
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Affiliation(s)
- Louise Wade
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Paul Kitching
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Emma De Winton
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Burch JM, Choi JS, Mosalem O, Charles L. Ectopic ACTH Production Caused by Metastatic Parotid Gland Acinic Cell Carcinoma. AACE Clin Case Rep 2021; 7:32-35. [PMID: 33718604 PMCID: PMC7924161 DOI: 10.1016/j.aace.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To present a case of adrenocorticotropic hormone (ACTH) hypersecretion caused by a metastatic acinic cell carcinoma (AcCC) of the parotid. Only 6 cases have been reported prior to October 2019. We believe that this condition is under-reported and hope that improved recognition will improve its reporting. Methods Diagnosis in this case was done using surgical pathology of the primary tumor, involving lymph nodes, and a metastatic lesion. Following an initial misdiagnosis, a final diagnosis of AcCC was made using immunohistochemical staining. ACTH hypersecretion was diagnosed by testing for random ACTH, cortisol, and 24-hour urine aldosterone and cortisol levels. Results A 57-year-old man presented with hypokalemia, lower-extremity edema, and left-side rib pain 7 months following excision of a 4-cm left-parotid tumor. Immunostaining positive for DOG-1, CK7, pan-cytokeratin (including CAM5.2), and SOX10 led to the diagnosis of AcCC. ACTH hypersecretion was diagnosed based on a random ACTH level of 307 pg/mL (normal morning value, 7.2-63 pg/mL), a cortisol level of 33 μg/dL (normal morning value, 4.3-19.8 μg/dL; normal PM value, 3.1-15.0 μg/dL), a 24-hour urine aldosterone level of <0.7 U (normal, 2.0-20 U), and a 24-hour urine cortisol level of 4564 U (normal, 3.5-45 U). The patient’s ACTH hypersecretion and hypokalemia were treated with potassium replacement, amiloride, and ketoconazole. His metastatic recurrence was treated with radiotherapy, chemotherapy, and immunotherapy. The patient died after being diagnosed with sepsis secondary to multifocal postobstructive pneumonia 4 months after the diagnosis of his metastatic recurrence. Conclusion Ectopic ACTH production caused by metastatic AcCC is a rare phenomenon but has been increasingly described over the last 15 years. We believe that this condition likely has a greater prevalence than what is reported and that improved recognition will lead to improved outcomes.
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Affiliation(s)
- Jacob M Burch
- Sparrow Hospital, Michigan State Internal Medicine Residency, Swartz Creek, Michigan
| | - James S Choi
- Sparrow Hospital, Michigan State Internal Medicine Residency, Swartz Creek, Michigan
| | - Osama Mosalem
- Sparrow Hospital, Michigan State Internal Medicine Residency, Swartz Creek, Michigan
| | - Lawrenshey Charles
- Sparrow Hospital, Michigan State Internal Medicine Residency, Swartz Creek, Michigan
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Lase I, Strele I, Grönberg M, Kozlovacki G, Welin S, Janson ET. Multiple hormone secretion may indicate worse prognosis in patients with ectopic Cushing's syndrome. Hormones (Athens) 2020; 19:351-360. [PMID: 31950464 PMCID: PMC7426294 DOI: 10.1007/s42000-019-00163-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Ectopic Cushing's syndrome (ECS) caused by an ACTH secreting neuroendocrine neoplasm (NEN) is a rare and challenging condition. We aimed to detect predictive and prognostic parameters for ECS patients identified from a retrospective, comprehensive cohort of NENs treated at a tertiary referral center. METHODS Medical records of 886 patients with NENs were reviewed. We identified 51 patients with ECS (33 females/18 men); mean age 52 ± 15 years (SD). Clinical parameters including symptoms, biochemical markers, and survival were extracted and further analyzed. RESULTS The primary tumor was located in the thorax (n = 28) or pancreas (n = 15) or was of unknown primary origin (n = 8). In 30 patients, tumor and ECS were diagnosed simultaneously. In 12 patients, the NEN diagnosis preceded ECS development, with a median time of 43.5 months (range: 9-96), and 10 of these showed radiological tumor progression at ECS diagnosis. Twenty-one patients had multiple hormone secretion, which correlated with shorter overall survival (OS), p = 0.012 (HR 2.4 (95% CI 1.2-4.9)), as did high morning cortisol, p = 0.037 (HR 2.3 (1.0-5.2)), higher tumor grade, p = 0.044 (HR 2.3 (1.0-5.1)), and diabetes, p = 0.050 (HR 2.4 (1.0-6.0)). CONCLUSIONS Multiple hormone secretion, high morning cortisol, higher tumor grade, and diabetes were correlated with shorter OS. Development of ECS in patients with a non-functioning NEN may indicate tumor progression. Multiple hormone secretion should be considered as a bad prognostic sign in ECS patients and should lead to intensified clinical management.
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Affiliation(s)
- Ieva Lase
- Department of Medical Sciences, Endocrine Oncology Unit, Uppsala University, SE-751 85, Uppsala, Sweden.
| | - Ieva Strele
- Department of Public Health and Epidemiology, Riga Stradins University, Dzirciema street 16, Riga, LV-1007, Latvia
| | - Malin Grönberg
- Department of Medical Sciences, Endocrine Oncology Unit, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Gordana Kozlovacki
- Department of Medical Sciences, Endocrine Oncology Unit, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Staffan Welin
- Department of Medical Sciences, Endocrine Oncology Unit, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Eva Tiensuu Janson
- Department of Medical Sciences, Endocrine Oncology Unit, Uppsala University, SE-751 85, Uppsala, Sweden
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7
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Ectopic Cushing's Syndrome Unveiling a Metastatic Parotid Carcinoma. Case Rep Endocrinol 2019; 2019:3196283. [PMID: 31737376 PMCID: PMC6815534 DOI: 10.1155/2019/3196283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/23/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction Adrenocorticotropic hormone (ACTH) ectopic production is a rare cause of Cushing syndrome (CS). The most commonly associated tumours are small-cell lung carcinoma along with bronchial and thymic carcinoids. To date, only 5 cases have been published in the literature featuring ectopic ACTH secretion from metastatic acinic cell carcinoma (ACC) of the parotid gland. We hereby describe a very uncommon case of ectopic CS (ECS) unveiling a metastatic parotid ACC. Case Presentation A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia. Hormonal study and dynamic biochemical tests performed indicated ECS. Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases. Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis. The patient underwent right parotidectomy, and histopathologic examination confirmed ACC. Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide. Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed. Conclusion The present report highlights a rare ECS, exposing a metastatic parotid ACC, with an aggressive and challenging clinical course, representing the first case whose diagnosis of ECS came prior to ACC.
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8
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Saluja K, Ravishankar S, Ferrarotto R, Zhu H, Pytynia KB, El-Naggar AK. Ectopic ACTH Production and Cushing's Syndrome in a Patient with Parotid Acinic Cell Carcinoma with High-Grade Transformation: Tumor Context and Clinical Implications. Head Neck Pathol 2019; 14:562-569. [PMID: 31363907 PMCID: PMC7235128 DOI: 10.1007/s12105-019-01054-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/10/2019] [Indexed: 12/26/2022]
Abstract
We report a rare case of Cushing's syndrome in a 59-year-old man who initially presented with concurrent acinic cell carcinoma of the parotid with high-grade transformation and co-existing papillary and medullary thyroid carcinomas, without noticeable cushinoid symptoms. Six-months later, he developed clinical features of Cushing's syndrome which coincided with disease progression in the form of lung metastasis and mediastinal lymphadenopathy. Ectopic adrenocorticotropic hormone (ACTH) production and protein expression was limited to the high-grade transformed component of acinic cell carcinoma and in the lymph node metastasis, and was absent in the conventional acinic cell carcinoma as well as in the papillary and medullary thyroid carcinoma. He received adjuvant chemotherapy and supportive management with interval improvement for 8 months followed by disease progression with increasing serum cortisol levels and bone metastasis. He was offered palliative chemotherapy, however, declined further therapy and was lost to follow up. We discussed clinical and pathologic implications of ectopic ACTH production associated with acinic carcinoma and also reviewed the literature of this rare paraneoplastic syndrome.
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Affiliation(s)
- Karan Saluja
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030 USA ,Department of Pathology, Unit 85, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030 USA
| | - Sanjita Ravishankar
- Department of Pathology, Unit 85, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030 USA ,Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Renata Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Hui Zhu
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030 USA
| | - Kristen B. Pytynia
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Adel K. El-Naggar
- Department of Pathology, Unit 85, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030 USA
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9
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Takeuchi M, Sato J, Manaka K, Tanaka M, Matsui H, Sato Y, Kume H, Fukayama M, Iiri T, Nangaku M, Makita N. Molecular analysis and literature-based hypothesis of an immunonegative prostate small cell carcinoma causing ectopic ACTH syndrome. Endocr J 2019; 66:547-554. [PMID: 30918166 DOI: 10.1507/endocrj.ej18-0563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ectopic ACTH syndrome (EAS) due to a prostate small cell carcinoma (SCC) is very rare with only 26 cases reported to date and has a poor prognosis. We here describe another case of this disorder that was clinically typical based on prior reports as it showed hypercortisolemia and severe hypokalemia with multiple metastasis. However, our current case of prostate SCC causing EAS is the first to display negative immunostaining for ACTH despite detectable POMC mRNA expression in the primary lesion. ACTH immunonegativity is thought to be associated with a more aggressive disease course and a poorer prognosis although there are few studies of the underlying mechanisms. We explored two possibilities for this finding in our current patient: aberrant POMC processing prevented immunodetection with an anti-ACTH antibody; and the ACTH content per cell was below the threshold for immunodetection due to its rapid secretion or low synthesis. The aberrant processing theory was thought to be less likely because of immunonegative findings even using anti-POMC/ACTH antibodies. As the plasma ACTH levels in our patient were comparable with those reported for previous immunopositive prostate EAS cases, we speculated that the depletion of ACTH may be caused not only by rapid secretion but also by low production levels as a sign of de-differentiation. De-differentiation may therefore explain the mechanism underlying the negative correlation between immunoreactivity for ACTH in EAS and disease aggressiveness. We believe that our present findings will be of use in future prospective studies aimed at confirming the mechanism of immunonegativity.
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Affiliation(s)
- Maki Takeuchi
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Junichiro Sato
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Katsunori Manaka
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Mariko Tanaka
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Hotaka Matsui
- Department of Urology, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, The University of Tokyo, Tokyo, Japan
| | | | - Taroh Iiri
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaomi Nangaku
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Noriko Makita
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
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10
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Intestinal Perforation in ACTH-Dependent Cushing's Syndrome. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9721781. [PMID: 31001560 PMCID: PMC6436364 DOI: 10.1155/2019/9721781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 02/21/2019] [Indexed: 01/25/2023]
Abstract
Previous studies have linked systemic glucocorticoid use with intestinal perforation. However, the association between intestinal perforation and endogenous hypercortisolism has not been well described, with only 14 previously published case reports. In this study, we investigated if intestinal perforation occurred more frequently in patients with ectopic ACTH syndrome and in those with a greater than 10-fold elevation of 24-hour urinary free cortisol level. Of 110 patients with ACTH-dependent Cushing's syndrome followed in two clinics in Canada, six cases with intestinal perforation were identified over 15 years. Age of patients ranged from 52 to 72, five females and one male, four with Cushing's disease and two with ectopic ACTH production, one from a pancreatic neuroendocrine tumor and one from medullary carcinoma of the thyroid. Five had diverticular perforation and one had intestinal perforation from a stercoral ulcer. All cases had their lower intestinal perforation when the cortisol production was high, and one patient had diverticular perforation 15 months prior to the diagnosis of Cushing's disease. As in previously reported cases, most had hypokalemia and abdominal pain with minimal or no peritoneal symptoms and this occurred during the active phase of Cushing's syndrome. Whereas all previously reported cases occurred in patients with 24-hour urinary free cortisol levels greater than 10-fold the upper limit of normal when measured and 11 of 14 patients had ectopic ACTH production, only one of our patients had this degree of hypercortisolism and four of our six patients had Cushing's disease. Similar to exogenous steroid use, patients with endogenous hypercortisolism also have a higher risk of intestinal, in particular diverticular, perforation and should be monitored closely for its occurrence with a low threshold for investigation and surgical intervention. Elective colonoscopy probably should be deferred until Cushing's syndrome is under control.
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11
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Dzeranova LK, Pigarova EA, Selivanova LS, Tarabrin EA, Slashchuk KY, Bibik EE. [Ectopic ACTH-syndrome caused by neuroendocrine tumor of lung]. Khirurgiia (Mosk) 2018:46-51. [PMID: 30307421 DOI: 10.17116/hirurgia2018090146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ectopic ACTH-syndrome is a relatively rare neuroendocrine disease. It is characterized by hypercortisolemia-associated severe complications that justifies need for timely diagnosis and radical therapy. Case report of young patient with ACTH-producing lung tumor is presented. There was 1-year diagnostic search on background of endogenous hypercorticism. Treatment resulted severe postoperative adrenal insufficiency that demonstrates current difficulties in management of these patients.
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Affiliation(s)
- L K Dzeranova
- National Medical Endocrinology Research Center of Healthcare Ministry of Russia, Moscow, Russia
| | - E A Pigarova
- National Medical Endocrinology Research Center of Healthcare Ministry of Russia, Moscow, Russia
| | - L S Selivanova
- National Medical Endocrinology Research Center of Healthcare Ministry of Russia, Moscow, Russia
| | - E A Tarabrin
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia
| | - K Yu Slashchuk
- National Medical Endocrinology Research Center of Healthcare Ministry of Russia, Moscow, Russia
| | - E E Bibik
- National Medical Endocrinology Research Center of Healthcare Ministry of Russia, Moscow, Russia
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12
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Sater ZA, Jha S, McGlotten R, Hartley I, El Lakis M, Araque KA, Nieman LK. Diverticular Perforation: A Fatal Complication to Forestall in Cushing Syndrome. J Clin Endocrinol Metab 2018; 103:2811-2814. [PMID: 29846662 PMCID: PMC6276718 DOI: 10.1210/jc.2018-00829] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/23/2018] [Indexed: 12/26/2022]
Abstract
CONTEXT Patients taking exogenous glucocorticoids are at risk for gastrointestinal (GI) complications, including peptic ulcer disease with perforation and gastric bleeding. However, little is known about the GI comorbidity in patients with endogenous hypercortisolemia. CASE DESCRIPTIONS We describe six patients with endogenous Cushing syndrome (CS) who developed sudden perforation of colonic diverticula necessitating urgent exploratory laparotomy. Most of these patients shared the following features of CS: skin thinning, severe hypercortisolemia (24-hour urinary free cortisol ≥10 times the upper limit of normal), ectopic secretion of ACTH, and severe hypokalemia. At the time of diagnosis of diverticular perforation (DP), these patients had minimal signs of peritonitis and lacked fever or marked leukocytosis. The diagnosis of DP was established by having a low threshold for obtaining an imaging study for evaluation of nonspecific abdominal pain. CONCLUSIONS Patients with CS can develop spontaneous surgical abdomen with rapid decompensation within hours. Prompt recognition is critical in the successful treatment of these patients.
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Affiliation(s)
- Zahraa Abdul Sater
- Diabetes, Obesity and Endocrinology Branch, National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Smita Jha
- Diabetes, Obesity and Endocrinology Branch, National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
- Clinical and Investigative Orthopedics Surgery Unit, National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda,
Maryland
- Correspondence and Reprint Requests: Smita Jha, MD, 10 Center Drive, Building 10-CRC, Room 4-1341, MSC 1468, Bethesda,
Maryland 20892. E-mail:
| | - Raven McGlotten
- Diabetes, Obesity and Endocrinology Branch, National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Iris Hartley
- National Institute of Child Health and Human Development, National Institutes
of Health, Bethesda, Maryland
| | - Mustapha El Lakis
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of
Health, Bethesda, Maryland
| | - Katherine A Araque
- Diabetes, Obesity and Endocrinology Branch, National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Lynnette K Nieman
- Diabetes, Obesity and Endocrinology Branch, National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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