HTA and hypokalemia: always think of cushing

Talbi Dounia; Elmoatamid Kaoutar; Sebbar Ghizlane; Rifai Kaoutar; Iraqi Hinde; El Hassan Gharbi Mohamed

doi:10.1530/endoabs.99.EP913

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Endocrine Abstracts (2024) 99 EP913 | DOI: 10.1530/endoabs.99.EP913

ECE2024 Eposter Presentations Pituitary and Neuroendocrinology (214 abstracts)

HTA and hypokalemia: always think of cushing’s disease

Talbi Dounia ¹ , Elmoatamid Kaoutar ¹ , Sebbar Ghizlane ¹ , Rifai Kaoutar ¹ , Iraqi Hinde ¹ & Gharbi Mohamed El Hassan ¹

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¹Ibn Sina University Hospital, Endocrinology, Rabat, Morocco

Introduction: Arterial hypertension of endocrine origin remains a rare and curable cause of hypertension. The association of hypertension and hypokalemia should always prompt us to consider cushing’s disease.

Case Report: A 39-year-old female patient, followed for 9 years for hypertension on dual therapy. Clinical examination was unremarkable, in whom the diagnosis of ACTH-dependent cushing’s syndrome was made on the basis of clinical and biological criteria with elevated ACTH at 52 pg/ml and hypokalemia at 3.2 mEq/l. Hypothalamic-pituitary MRI showed a 6-mm pituitary microadenoma.

Discussion and Conclusion: Hypokalemia is a frequent finding in patients with cushing’s disease. In the presence of hypercortisolism, the conversion of cortisol to cortisone may be saturated by a decrease in 11B-hydroxysteroid dehydrogenase (type 2) activity, so cortisol has an affinity for the mineralocorticoid receptor identical to that of aldosterone, leading to stimulation of the mineralocorticoid receptor in the renal tubules, inducing an increase in mineralocorticoid activity, with increased sodium reabsorption and potassium excretion, increased bicarbonate reabsorption and higher blood pressure. Consequently, this combination of hypertension and hypokalemia should suggest cushing’s disease in particular, when other causes have been ruled out.