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.
摘要：
虽然罕见，内源性皮质醇血症，包括库欣病（CD），已知会导致肠穿孔并掩盖肠穿孔的典型症状，导致延迟诊断。此外,老年CD患者发生肠穿孔的风险较高,因为老年人肠组织脆性有增加的趋势.在这里，我们描述了一例罕见病例,其中一名年轻的成人CD患者在严重腹痛后被诊断为与CD相关的肠穿孔.一名24岁的日本男子入院评估ACTH依赖性库欣综合征。他在住院的第8天突然抱怨严重的腹痛。计算机断层扫描显示乙状结肠周围有自由空气。病人被诊断为肠穿孔,接受了紧急手术,被救了.他随后被诊断出患有CD，经蝶切除垂体腺瘤。迄今为止,据报道有8例CD引起的肠穿孔，肠穿孔时的平均年龄为61岁。在一半的患者中检测到低钾血症，都有憩室病的病史.然而，没有多少患者抱怨腹膜刺激。总之,这是最年轻的CD引起的肠穿孔病例,也是首例无憩室疾病史的肠穿孔患者.肠穿孔可能发生在CD患者中，无论年龄和低钾血症的存在，憩室病,或腹膜刺激。
