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Subclinical Cushing Syndrome Presenting With Hypertension and Hypokalemia

Torun, Ayse Nur Izol MD; Gursoy, Alptekin MD; Unal, Asli Dogruk MD; Demirag, Nilgun Guvener MD

doi: 10.1097/TEN.0b013e31813435ea
Case Report
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A 44-year-old woman presented with hypokalemia and poorly controlled hypertension despite taking 3 nondiuretic antihypertensive drugs. Physical examination was normal, except for elevated blood pressure. Initial laboratory evaluation revealed a serum potassium concentration of 2.5 mEq/L, with plasma renin, aldosterone, and the aldosterone/renin ratio within the normal ranges. Early-morning serum cortisol was 30 μg/dL, and 24-hour urinary free cortisol concentration was 309 μg/d. The serum adrenocorticotropic hormone level was suppressed. Serum cortisol was not suppressed by low- or high-dose dexamethasone. Adrenal computed tomography revealed a right-sided, 3- × 2-cm adrenal mass. After a right adrenalectomy, she became normotensive without any medication, other than parenteral glucocorticoid as replacement therapy. Following withdrawal of the corticosteroid, serum potassium concentration became normal. On the sixth postoperative day, she was discharged, with a serum potassium concentration of 4.5 mEq/L. Six months after surgery, she is still normotensive and normokalemic. Hypokalemia is a frequent manifestation of adrenocorticotropic hormone-dependent Cushing syndrome (CS), but it is rarely reported in adrenal CS. After excluding other possible causes of hypokalemia, the possibility of a partial 11-β-hydroxysteroid-dehydrogenase deficiency was entertained. This case underscores the variable clinical presentation of subclinical CS and the importance of considering CS as a cause of hypokalemic hypertension.

From the Baskent University Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey.

Reprints: Ayse Nur Izol Torun, Department of Endocrinology and Metabolic Disease, Konya Medical Research and Teaching Center, Baskent University, Saray Street No. 1, Selcuklu, 42080, Konya, Turkey. E-mail: aysenurizol@yahoo.com.

© 2007 Lippincott Williams & Wilkins, Inc.