Endocrine Abstracts

Hypokalemia is a common and potentially fatal electrolyte disturbance, especially in hospitalised patients. Therefore, prompt assessment and management is vital to avoid serious complications. We report a case of 77 Year old gentleman with a background of Alzheimer’s presenting with abdominal distension, intermittent diarrhoea and shortness of breath. He had normal blood pressure with no signs of Cushing syndrome but was found to have hypokalaemia. Plain imaging revealed dilated markedly distended bowel loops. CT pulmonary angiogram found bilateral pulmonary embolism, which was treated with apixaban. CT imaging also revealed colonic pseudo-obstruction and fat rich left adrenal nodule. Due to Type 1 respiratory failure, he required three days of intubation and ventilation. Hypokalaemia worsened requiring intravenous potassium replacement. His breathing and diarrhoea improved, but he had persistent hypokalaemia despite oral and intravenous potassium replacement. Flexi-sigmoidoscopy and partial thickness colonic biopsy was unremarkable. He was deemed unfit for colectomy due to his comorbidities. Endocrine biochemistry revealed raised 24 h urinary cortisol, non-suppressed cortisol after overnight dexamethasone suppression test and low renin and aldosterone. He had inappropriately normal 24 h urinary potassium, normal serum bicarbonate and magnesium. Addition of spironolactone and eplerenone normalised potassium levels. He has clinically improved and further testing is being performed to establish an endocrine diagnosis. The cause of hypokalemia in this case is unclear. The differentials include gastrointestinal or renal loss and the latter could be due to possible hypercortisolism. Irrespective of the cause, clinicians should consider treating hypokalaemia before a cause could be established in situations where hypokalaemia could be contributing to a potentially life threatening condition. It is also important to emphasize that patients have physiological hypercortisolism during periods of illness and hence endocrine testing must be repeated when the stress of illness is over.