{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:58:25Z","timestamp":1781009905120,"version":"3.54.1"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":159,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Endocrinology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Ectopic adrenocorticotropic hormone (ACTH)\u2010dependent Cushing\u2019s syndrome (CS), ectopic ACTH secretion (EAS) is a rare condition caused by ACTH\u2010secreting neuroendocrine tumors (NETs), such as bronchial carcinoids. We report a 65\u2010year\u2010old woman with severe EAS complicated by bowel perforation. She presented with hypokalemia (K\n                    <jats:sup>+<\/jats:sup>\n                    2.3\u2009mmol\/L), metabolic alkalosis, resistant hypertension (180\/110\u2009mmHg), worsening diabetes (HbA1c 6.7%\u20139.1%), proximal muscle weakness, and 14\u2009kg weight gain over 3 months. A silent sigmoid colon perforation required emergency resection and colostomy. Biochemical tests confirmed hypercortisolism (urine free cortisol [UFC], 1256\u2009\u00b5g\/24\u2009h, plasma ACTH 175\u2009pg\/mL, and cortisol &gt;40\u2009\u00b5g\/dL post\u2010dexamethasone). Imaging identified a 2.3\u2009cm pulmonary nodule with mild uptake on Ga\u201068 DOTATATE PET\/CT. Bronchoscopic biopsy confirmed an ACTH\u2010positive low\u2010grade bronchial carcinoid tumor. Initial treatment with osilodrostat was interrupted due to acute illness and oral medication intolerance. Intravenous etomidate was employed in the ICU for rapid cortisol suppression, followed by resumption of osilodrostat after stabilization. Thoracoscopic lobectomy confirmed a low\u2010grade carcinoid tumor (Ki\u201067\u2009&lt;\u20092%). Postoperatively, cortisol normalized, electrolytes stabilized, and HbA1c improved to 6.5%. This case highlights bowel perforation as a severe complication of EAS and underscores the importance of dynamic, alternating therapy with osilodrostat and etomidate, along with individualized surgical and medical management strategies.\n                  <\/jats:p>","DOI":"10.1155\/crie\/4689206","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:59:55Z","timestamp":1781006395000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Alternating Therapy With Osilodrostat and Etomidate in Severe Ectopic Cushing\u2019s Syndrome Complicated by Silent Bowel Perforation"],"prefix":"10.1155","volume":"2026","author":[{"given":"Hery","family":"Mejia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Villabona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Savian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana 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