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Case Reports
. 2019 Jan 18;12(1):bcr-2018-227068.
doi: 10.1136/bcr-2018-227068.

Hypokalaemic metabolic alkalosis, hypertension and diabetes: what is the link

Marius Vögelin  1 , Richard Cathomas  2 , Niklaus Kamber  3 , Thomas Fehr  1
Affiliations
Case Reports

Hypokalaemic metabolic alkalosis, hypertension and diabetes: what is the link

Marius Vögelin et al. BMJ Case Rep. .

Abstract

Two years after diagnosis of a metastatic neuroendocrine gastrin-secreting tumour and after several cycles of chemotherapy and peptide receptor radionuclide therapy, a 56-year-old woman presented with hypokalaemic metabolic alkalosis, hypertension, leg oedema and new-onset diabetes mellitus. Further investigations revealed renal potassium loss confirmed by a transtubular potassium gradient of 16, fully suppressed serum aldosterone, but instead highly elevated blood levels of morning cortisol and adrenocorticotropic hormone as well as increased urinary excretion of glucocorticoid and mineralocorticoid metabolites. Ruling out other causes, paraneoplastic hypercortisolism was diagnosed. Pharmacological inhibition of the steroid 11β-hydroxylase with metyrapone resulted in complete resolution of metabolic alkalosis, hypokalaemia, hypertension, hyperglycaemia and leg oedema within 1 week.

Keywords: diabetes; drugs: endocrine system; endocrine cancer; fluid electrolyte and acid-base disturbances; hypertension.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Liver biopsy showing metastasis of the neuroendocrine tumour. Inset: immunohistochemistry Ki-67 with proliferative index of about 50.
Figure 2
Figure 2
Biopsy of liver metastasis demonstrating gastrin production of the tumour cells by brown precipitates in the immunohistochemistry for gastrin.
See this image and copyright information in PMC

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