Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May;7(1):148-152.
doi: 10.1007/s13730-018-0315-4. Epub 2018 Feb 15.

Hypokalemia associated with pseudo-Cushing's syndrome and magnesium deficiency induced by chronic alcohol abuse

Masafumi Kurajoh  1 , Keiko Ohsugi  2 , Miki Kakutani-Hatayama  2 , Takuhito Shoji  2 , Hidenori Koyama  2
Affiliations

Hypokalemia associated with pseudo-Cushing's syndrome and magnesium deficiency induced by chronic alcohol abuse

Masafumi Kurajoh et al. CEN Case Rep. 2018 May.

Abstract

Hypokalemia and hypomagnesemia are frequently observed in patients with chronic alcoholism. However, the involvement of deranged cortisol regulation in patients with those conditions has not been reported. A 63-year-old Japanese male with chronic alcoholism was referred to the Department of Diabetes, Endocrinology and Metabolism for examination and treatment of hypokalemic periodic paralysis. Laboratory findings showed hypokalemia (2.3 mmol/l), as well as a high level of urinary excretion of potassium and hypomagnesemia (1.2 mg/dl), whereas urinary excretion of magnesium was undetectable. Potassium infusion treatment recovered that level in serum to 4.1 mmol/l, though it decreased to 2.2 mmol/l following discontinuation. A dexamethasone suppression test and urinary cortisol level showed corticotropin-dependent hypercortisolemia. However, gadolinium-enhanced MRI revealed no evidence of pituitary adenoma. The patient recovered from hypokalemia following an administration of magnesium in addition to potassium, which was accompanied by potassium over-excretion improvement. After being discharged, serum potassium level was maintained within a normal range with only magnesium infusion treatment. Furthermore, alcohol intake was reduced from 160 to 20 g/day and an endocrinological re-examination after that restriction showed normal cortisol regulation. The patient was diagnosed with pseudo-Cushing's syndrome induced by alcohol abuse. Serum potassium level was maintained within a normal range even after discontinuation of magnesium supplementation. Our findings in this case indicate that pseudo-Cushing's syndrome in conjunction with hypomagnesemia may be involved in development of hypokalemia in patients with chronic alcoholism.

Keywords: Hypokalemia; Magnesium administration; Magnesium deficiency; Pseudo-Cushing syndrome.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

All the authors have declared no competing interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from the patient for publication of this case report and any accompanying images.

Figures

Fig. 1
Fig. 1
Clinical course of potassium metabolism and serum magnesium levels. FEK fractional excretion of potassium, TTKG trans-tubular potassium gradient
See this image and copyright information in PMC

References

    1. De Marchi S, Cecchin E, Basile A, Bertotti A, Nardini R, Bartoli E. Renal tubular dysfunction in chronic alcohol abuse—effects of abstinence. N Engl J Med. 1993;329(26):1927–1934. doi: 10.1056/NEJM199312233292605. - DOI - PubMed
    1. Elisaf M, Liberopoulos E, Bairaktari E, Siamopoulos K. Hypokalaemia in alcoholic patients. Drug Alcohol Rev. 2002;21(1):73–76. doi: 10.1080/09595230220119282a. - DOI - PubMed
    1. Whang R, Whang DD. Update: mechanisms by which magnesium modulates intracellular potassium. J Am Coll Nutr. 1990;9(1):84–85. doi: 10.1080/07315724.1990.10720354. - DOI - PubMed
    1. Huang CL, Kuo E. Mechanism of hypokalemia in magnesium deficiency. J Am Soc Nephrol. 2007;18(10):2649–2652. doi: 10.1681/ASN.2007070792. - DOI - PubMed
    1. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med. 1992;152(1):40–45. doi: 10.1001/archinte.1992.00400130066006. - DOI - PubMed

LinkOut - more resources