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| Case | Age Gender | Presentation | Laboratory Investigations | Imaging Investigations | Etiology | Treatment |
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| 1 | 72, Female | Nausea, vomiting, abdominal pain, hypokalemia from diverticular rupture;
cushingoid features,
hypertension and type 2 diabetes mellitus | At presentation/around time of perforation:
Cortisol 3243 nmol/L, ACTH 33.2 pmol/L UFC 5296 nmol
Chromogranin A – 81 U/L
Glucagon – 91.2 ng/L | CT head – negative
CT abdomen - 6 cm pancreatic mass with calcifications
Octreotide scan – uptake within pancreatic mass | Biopsy confirmed pancreatic neuroendocrine tumor | Hartmann procedure; ketoconazole, metyrapone, and octreotide for hypercortisolism |
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| 2 | 61, Female | Known metastatic medullary thyroid carcinoma, hypokalemia, dyspnea, abdominal pain from diverticular rupture | Around time of perforation:
Cortisol 1925 nmol/L, ACTH 49.9 pmol/L
UFC – not done | CT abdomen – 2 cm bilateral adrenal masses with no uptake on MIBG scan | Presumed ectopic from medullary thyroid carcinoma | Conservative management |
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| 3 | 68, Female | Known Cushing’s disease with recurrence ten years after surgery;
worsening glycemic control, left lower quadrant abdominal pain, elevated liver enzymes from diverticular rupture | At presentation:
Cortisol 600 nmol/L, ACTH 16.3 pmol/L
UFC 1088 nmol (<300 nmol)
Around time of perforation:
Cortisol 797 nmol/L, ACTH 48.0 pmol/L
UFC 410 nmol
Before second rupture:
Cortisol 568 nmol/L, ACTH 18.7 pmol/L
UFC 348 nmol | At presentation:
MRI sella – left-sided adenoma
At time of recurrence: MRI sella - 3 mm lesion not amenable to surgery | Cushing’s disease recurrence, corticotroph adenoma | IV antibiotics, cabergoline after initial rupture;
Right hemicolectomy for diverticular tear |
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| 4 | 71, Female | Hypertension, type 2 diabetes mellitus, hypokalemia, lower abdominal pain;
chronic perforation, extensive sigmoid diverticular disease | At presentation/around time of perforation:
Cortisol 1228 nmol/L, ACTH 13.5 pmol/L
UFC 1533 nmol (N <220 nmol) | MRI sella - 3 mm adenoma;
CT abdomen – stable 2 cm bilobed left adrenal adenoma/ hyperplasia | Cushing’s disease, corticotroph adenoma | IV antibiotics before transsphenoidal surgery |
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| 5 | 54, Male | Persistent Cushing’s disease post-surgery, on cabergoline; lower abdominal pain, sigmoid colon perforation | At presentation:
Cortisol 469 nmol/L after 1 mg dexamethasone, ACTH 19.4 pmol/L, UFC 374 nmol (N<220 nmol)
Around time of perforation:
UFC 328 nmol (N<166 nmol) | MRI sella – normal | Cushing’s disease, corticotroph adenoma | Surgical management of stercoral ulcer perforation and resumption of cabergoline |
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| 6 | 52, Female | Abdominal pain with symptoms of vaginal fistula and symptoms of of hypercortisolism | 15 months post-surgical repair of diverticular rupture:
Cortisol 1125 nmol/L, ACTH 11 pmol/L
UFC 885 nmol | MRI sella – 4 mm left-sided adenoma | Cushing’s disease, corticotroph adenoma | Surgical management |
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