Colorectal manifestations of endocrine disease.
OBJECTIVE
The aim of this review is to alert the colon and rectal surgeon to the colorectal manifestations of endocrine disease.


METHODS
This report was obtained by a review of the medical literature. Endocrine disease may initially present as a symptom felt to be referable to colorectal disease. Furthermore symptoms of well-established endocrine disorders may have refractory colorectal symptoms.


RESULTS
Constipation is the most common gastrointestinal symptom of diabetics; however, in patients with brittle diabetes, diarrhea may be chronic and intermittent. Unexplained diarrhea, despite an exhaustive work-up for an etiology, should alert the clinician to the possibility of a pancreatic endocrine tumor. Thyroid disorders, depending on activity of the gland, may have refractory constipation, diarrhea, or steatorrhea as the only presenting symptoms. Constipation is a common symptom of hypercalcemia, secondary to hyperparathyroidism. Primary hyperparathyroidism has been associated with increased incidence of malignancies, specifically of colonic origin. In patients with acromegaly a threefold to eightfold increased risk of colon carcinoma or adenomatous polyps is seen. Chronic adrenal insufficiency may present initially as diarrhea and malabsorption. The adrenal gland is a frequent site of metastases from colorectal cancer. Pheochromocytomas may be a cause of occult gastrointestinal bleeding or ischemic colitis.


CONCLUSIONS
Unexplained symptoms referable to the colon and rectum should alert the clinician to the possibility of an underlying endocrine disorder.
Sharma
S
S
Department of Surgery, St. Louis University School of Medicine, Missouri 63110-0250.
Longo
W E
WE
Baniadam
B
B
Vernava
A M
AM
D003108:Colonic Diseases / Q000150:complications*; D004700:Endocrine System Diseases / Q000150:complications*; D006801:Humans; D012002:Rectal Diseases / Q000150:complications*