A Rare Entity in Cushing’s Disease: Severe Hypokalemia and Metabolic Alkalosis Hypokalemia and Metabolic Alkalosis in Cushing’s Disease

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Seda Turgut
Muzaffer Ilhan
Rabia Soytas
Murat Alay
Rumeyza Kazancioglu


Objective: This case report aimed to highlight the prominence of considering Cushing's disease (CD) in the differential diagnosis of severe hypokalemia and metabolic alkalosis.

Case Report: A 63-year-old woman who was admitted to the emergency room with fatigue and severe weakness of extremities. Biochemistry results indicated severe hypokalemia (potassium = 1.2 mmol/L) and metabolic alkalosis (pH = 7.83) and based on further endocrinological investigations, the final diagnosis of CD was confirmed, and magnetic resonance imaging revealed a microadenoma in the right side of the pituitary gland. Transsphenoidal surgery was performed. After surgery, biochemical assessments showed normal potassium levels and corrected metabolic alkalosis without any further treatment. The hypothalamic–pituitary–adrenal axis recovered in nearly eight months and  the patient was in remission.

Conclusions: Although hypokalemia could be present in CD, none of the previous studies have reported hypokalemia as severe as in this case. This case report highlighted the prominence of considering CD in the differential diagnosis of severe hypokalemia and metabolic alkalosis that could be a crucial part of biochemical features in CD.


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Turgut, S., Ilhan, M., Soytas, R., Alay, M., & Kazancioglu, R. (2021). A Rare Entity in Cushing’s Disease: Severe Hypokalemia and Metabolic Alkalosis. Medical Science and Discovery, 8(3), 189-192. https://doi.org/10.36472/msd.v8i3.492
Case Reports


1. Nishioka H, Yamada S. Cushing's Disease. Journal of clinical medicine. 2019;8(11).

2. Nieman LK. Cushing's syndrome: update on signs, symptoms and biochemical screening. European journal of endocrinology / European Federation of Endocrine Societies. 2015;173(4):M33-8.

3. Torpy DJ, Mullen N, Ilias I, Nieman LK. Association of hypertension and hypokalemia with Cushing's syndrome caused by ectopic ACTH secretion: a series of 58 cases. Annals of the New York Academy of Sciences. 2002;970:134-44.

4. Martinez-Valles MA, Palafox-Cazarez A, Paredes-Avina JA. Severe hypokalemia, metabolic alkalosis and hypertension in a 54 year old male with ectopic ACTH syndrome: a case report. Cases journal. 2009;2:6174.

5. Badiu C, Capatana C, Cristofor D, Mircescu G, Coculescu M. APPARENT MINERALOCORTICOID EXCESS IN A CASE OF LUNG PARANEOPLASTIC CUSHING SYNDROME. Acta Endocrinologica (1841-0987). 2005;1(1).

6. Kishimoto S, Hirota K, Segawa H, Fukuda K. Ectopic ACTH syndrome revealed as severe hypokalemia and persistent hypertension during the perioperative period: a case report. Journal of anesthesia. 2011;25(1):104-7.

7. Kikuchi H, Yoshimoto T, Tanaka H, Tsujimoto K, Yamamura C, Arai Y, et al. Periodic hypokalemia associated with cyclic Cushing’s syndrome. CEN case reports. 2014;3(1):80-5.

8. Kaltsas GA, Giannulis MG, Newell-Price JD, Dacie JE, Thakkar C, Afshar F, et al. A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing's disease and the occult ectopic adrenocorticotropin syndrome. The Journal of clinical endocrinology and metabolism. 1999;84(2):487-92.

9. Pecori Giraldi F, Moro M, Cavagnini F, Study Group on the Hypothalamo-Pituitary-Adrenal Axis of the Italian Society of E. Gender-related differences in the presentation and course of Cushing's disease. The Journal of clinical endocrinology and metabolism. 2003;88(4):1554-8.

10. Titan SM, Gebara OC, Callas SH, Hoff AO, Hoff PM, Galvão P. Case report: a rare cause of metabolic alkalosis. Nephrology Dialysis Transplantation Plus. 2011;4(3):164-6.

11. Ulick S, Wang JZ, Blumenfeld JD, Pickering TG. Cortisol inactivation overload: a mechanism of mineralocorticoid hypertension in the ectopic adrenocorticotropin syndrome. The Journal of clinical endocrinology and metabolism. 1992;74(5):963-7.

12. Seckl JR. 11 beta-hydroxysteroid dehydrogenase isoforms and their implications for blood pressure regulation. European journal of clinical investigation. 1993;23(10):589-601.

13. Schambelan M, Slaton PE, Jr., Biglieri EG. Mineralocorticoid production in hyperadrenocorticism. Role in pathogenesis of hypokalemic alkalosis. The American journal of medicine. 1971;51(3):299-303.

14. Ferrari P, Krozowski Z. Role of the 11beta-hydroxysteroid dehydrogenase type 2 in blood pressure regulation. Kidney international. 2000;57(4):1374-81.