Abstract:Ectopic ActH production occurs in about 10% of all cases of cushing's syndrome, and about 25% of cases of ActH-dependent cushing's syndrome. diverse tumor types are able to produce ActH ectopically, including small cell lung carcinoma. Ectopic ActH secretion by malignant neoplasm has been reported to have earlier and more aggressive metabolic effects. We report a 59-year-old male patient with severe hypertension, metabolic alkalosis and hypokalemia as the first clinical manifestations of an ActH-secreting smal… Show more
“…Hypokalemia occurred if there was severe hypercortisolism in both CD and ectopic ACTH patients. 4,9,18,[25][26][27][28] Moreover, the UFF/UFE ratio in patients with hypokalemia was significantly higher than that in adrenal CS patients with normokalemia (P < 0.001), suggesting that 11β-HSD2 deficiency was ACTH independent. 29 Otherwise, we analyzed the incidence of hypokalemia in patients hospitalized in our department with ACTH-independent cortisol-secreting adrenal adenoma and carcinoma.…”
Section: Discussionmentioning
confidence: 91%
“…The results above indicated that ACTH was not as relevant as cortisol in contributing to hypokalemia. Hypokalemia occurred if there was severe hypercortisolism in both CD and ectopic ACTH patients . Moreover, the UFF/UFE ratio in patients with hypokalemia was significantly higher than that in adrenal CS patients with normokalemia ( P < 0.001), suggesting that 11β‐HSD2 deficiency was ACTH independent…”
Hypokalemia is a common feature in patients with Cushing's syndrome (CS). Whether the occurrence of hypokalemia is associated with cortisol and adrenocorticotropic hormone (ACTH) levels is still unclear. Approximately 80% of cases of endogenous CS are due to Cushing's disease (CD). The purpose of this study was to determine the association of hypokalemia with cortisol and ACTH levels in patients with CD. The retrospective study included 195 patients with CD referred to our medical center from January 2011 to December 2017. The results show that 25.64% (50/195) of the patients had hypokalemia. The 24‐h urinary free cortisol (UFC) and plasma cortisol levels were significantly higher in patients with hypokalemia than those with normokalemia (P < 0.05). Plasma ACTH levels were similar between the patients with hypokalemia and normokalemia (P > 0.05). Cortisol levels were negatively correlated with plasma potassium levels (08:00: r = −0.344 (P < 0.01), 00:00: r = −0.435 (P < 0.01); 24‐h UFC: r = −0.281 (P < 0.05)). There was no significant correlation between the plasma ACTH and potassium (08:00: r = −0.093 (P > 0.05), 00:00: r = −0.184 (P > 0.050)). Our current data suggest that cortisol level, instead of ACTH level, is correlated with plasma potassium level. A high cortisol level may be the principal cause of hypokalemia.
“…Hypokalemia occurred if there was severe hypercortisolism in both CD and ectopic ACTH patients. 4,9,18,[25][26][27][28] Moreover, the UFF/UFE ratio in patients with hypokalemia was significantly higher than that in adrenal CS patients with normokalemia (P < 0.001), suggesting that 11β-HSD2 deficiency was ACTH independent. 29 Otherwise, we analyzed the incidence of hypokalemia in patients hospitalized in our department with ACTH-independent cortisol-secreting adrenal adenoma and carcinoma.…”
Section: Discussionmentioning
confidence: 91%
“…The results above indicated that ACTH was not as relevant as cortisol in contributing to hypokalemia. Hypokalemia occurred if there was severe hypercortisolism in both CD and ectopic ACTH patients . Moreover, the UFF/UFE ratio in patients with hypokalemia was significantly higher than that in adrenal CS patients with normokalemia ( P < 0.001), suggesting that 11β‐HSD2 deficiency was ACTH independent…”
Hypokalemia is a common feature in patients with Cushing's syndrome (CS). Whether the occurrence of hypokalemia is associated with cortisol and adrenocorticotropic hormone (ACTH) levels is still unclear. Approximately 80% of cases of endogenous CS are due to Cushing's disease (CD). The purpose of this study was to determine the association of hypokalemia with cortisol and ACTH levels in patients with CD. The retrospective study included 195 patients with CD referred to our medical center from January 2011 to December 2017. The results show that 25.64% (50/195) of the patients had hypokalemia. The 24‐h urinary free cortisol (UFC) and plasma cortisol levels were significantly higher in patients with hypokalemia than those with normokalemia (P < 0.05). Plasma ACTH levels were similar between the patients with hypokalemia and normokalemia (P > 0.05). Cortisol levels were negatively correlated with plasma potassium levels (08:00: r = −0.344 (P < 0.01), 00:00: r = −0.435 (P < 0.01); 24‐h UFC: r = −0.281 (P < 0.05)). There was no significant correlation between the plasma ACTH and potassium (08:00: r = −0.093 (P > 0.05), 00:00: r = −0.184 (P > 0.050)). Our current data suggest that cortisol level, instead of ACTH level, is correlated with plasma potassium level. A high cortisol level may be the principal cause of hypokalemia.
“…In the majority of patients, hypokalemia is the first clinical manifestation of EAS [17,18]. In the case reported in this paper, hypokalemia and muscle weakness of the bilateral legs were clinically detected during the course of chemotherapy but not at the time of initial diagnosis.…”
“…The authors report on a case of a patient that presented with severe hyperglycemia and refractory hypokalemic metabolic alkalosis that upon investigation was compatible with CD. In the case reports that have described a similar presenting clinical picture, the underlying cause was always ectopic ACTH secretion (7)(8)(9)(10). The diagnosis of CD was unexpected; therefore, we believe that this case report is noteworthy.…”
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