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. 2014 May;3(1):80-85.
doi: 10.1007/s13730-013-0090-1. Epub 2013 Aug 9.

Periodic hypokalemia associated with cyclic Cushing's syndrome

Hiroaki Kikuchi  1 , Takanobu Yoshimoto  2 , Hiroyuki Tanaka  3 , Kazutaka Tsujimoto  2 , Chisato Yamamura  3 , Yohei Arai  3 , Suguru Hirasawa  3 , Shota Aki  3 , Naoto Inaba  3 , Makoto Aoyagi  3 , Yoshihiro Ogawa  2 , Teiichi Tamura  3
Affiliations

Periodic hypokalemia associated with cyclic Cushing's syndrome

Hiroaki Kikuchi et al. CEN Case Rep. 2014 May.

Abstract

A 69-year-old woman presented with periodic hypertension, edema, and hypokalemia that occurred within an interval of a few weeks. Her laboratory test values showed autonomously elevated plasma adrenocorticotropic hormone (ACTH) and cortisol concentrations. The patient's Cushingoid features were not evident on first admission. Several weeks later, in spite of constant oral potassium supplementation, severe hypokalemia recurred with Cushingoid features and worsening symptoms of leg edema and pigmentation, which spontaneously disappeared within a few days. Her periodic symptoms occurred in parallel with fluctuations of plasma ACTH and cortisol concentrations. A series of endocrinological and pituitary imaging findings led to a tentative diagnosis of cyclic Cushing's syndrome caused by ectopic ACTH secretion. However, chest and abdominal computed tomography did not reveal any candidate lesion. The patient's periodic hypercortisolemia and symptoms were well controlled after treatment with metyrapone plus dexamethasone. This is a very rare case of periodic hypokalemia and hypertension caused by cyclic Cushing's syndrome.

Keywords: Cyclic Cushing’s syndrome; Ectopic ACTH syndrome; Hypokalemia.

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Figures

Fig. 1
Fig. 1
Magnetic resonance imaging (MRI) scan of the patient’s pituitary gland. T1-weighted, gadolinium-contrast-enhanced coronal view. No candidate lesion was detectable in her pituitary
See this image and copyright information in PMC

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