Journal
BMJ CASE REPORTS
Volume 14, Issue 8, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bcr-2021-244850
Keywords
metabolic disorders; pituitary disorders; fluid electrolyte and acid-base disturbances
Categories
Ask authors/readers for more resources
A 68-year-old female presented with refractory hypokalemic hypertension and metabolic alkalosis, raising suspicion of Cushing's syndrome (CS). Further investigation confirmed ACTH-dependent CS, with treatment resulting in significant improvement of symptoms.
A 68-year-old woman presented with right arm cellulitis, not responsive to oral antibiotics. Intravenous antibiotics were commenced, and an ultrasound scan confirmed a collection that was surgically drained. She developed refractory hypokalaemia with normal magnesium, no gastrointestinal losses and no iatrogenic cause. She was hypertensive, hyperglycaemic, alkalotic, clinically obese with proximal myopathy and skin bruising. These clinical findings and refractory hypokalaemic hypertension with metabolic alkalosis raised a suspicion of Cushing's syndrome (CS). 24-hour urinary free cortisol (24 hours) was grossly raised on two occasions. The adrenocorticotropic hormone (ACTH) was significantly raised at 154 ng/L, confirming ACTH-dependant CS. A CT scan of the thorax, abdomen and pelvis excluded an ectopic source of hypercortisolaemia. MRI pituitary revealed an invasive macroadenoma. Treatment with endoscopic debulking resulted in the resolution of hypokalaemia and metabolic alkalosis with significant improvement in hyperglycaemia and hypertension.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available