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Unusual Triad of Obstructive Sleep Apnea, Uncontrolled Hypertension, and Severe Hypokalemia Due to Ectopic Adrenocorticotropic Secretion

Venkatram, Sindhaghatta MD, FCCP*; Vakde, Trupti MD; Badipatla, Kanthi MD; Niazi, Masooma MD§; Diaz-Fuentes, Gilda MD, FCCP*

Journal of Bronchology & Interventional Pulmonology: April 2014 - Volume 21 - Issue 2 - p 158–161
doi: 10.1097/LBR.0000000000000060
Case Reports

Ectopic adrenocorticotropic hormone secretion is responsible for 12% to 17% of all cases of the Cushing syndrome. One of the most commonly described causes of ectopic adrenocorticotropic hormone secretion is small cell carcinoma of the lung. A rare cause includes a functioning neuroendocrine tumor traditionally known as carcinoids that account for 5% of all mediastinal tumors. To our knowledge, all reported cases of mediastinal carcinoids are thymic in origin and only a minority of those is functional. We present a male patient with hypertension, obstructive sleep apnea, and acid-base disorder, in whom further investigation revealed an anterior mediastinal mass and Cushing syndrome.

*Division of Pulmonary and Critical Care Medicine

Division of Pulmonary and Critical Care Medicine

Departments of Internal Medicine

§Pathology, Bronx Lebanon Hospital Center, Bronx, NY

T.V. and K.B. wrote draft of the manuscript; G.D.-F. and S.V. revised the manuscript critically for important intellectual content and gave final approval of the version to be published. M.N. has been involved in obtaining and revising pathological images.

Disclosure: There is no conflict of interest or other disclosures.

Reprints: Gilda Diaz-Fuentes, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, NY 10457 (e-mail:

Received May 24, 2013

Accepted February 17, 2014

© 2014 by Lippincott Williams & Wilkins.