SHM Converge Scientific Abstract ePoster Gallery-Refractory Hypertension and Diabetes With Hypokalemia, a Sign of Cancer?

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An 83-year-old woman with hypertension and type 2 diabetes was hospitalized for weakness, severe hyperglycemia, and hypokalemia. Her electrolyte abnormalities were initially attributed to recent hydrochlorothiazide use, and she was discharged with potassium supplementation and stopping diuretics. One week later, she was readmitted with dyspnea, weakness, leg swelling, persistent hypertension, bruising, hyperglycemia, and recurrent hypokalemia despite treatment.<br /><br />Because the combination of refractory hypertension, diabetes, and hypokalemia suggested an endocrinopathy, the team evaluated her for hypercortisolism. Laboratory testing showed markedly elevated random and late-night cortisol and a very high ACTH level, confirming ACTH-dependent Cushing syndrome. Imaging was pursued early, given concern for ectopic ACTH production rather than pituitary disease. Abdominal MRI revealed widespread metastatic disease involving the liver, right adrenal gland, and spine, and chest CT showed a pulmonary nodule with bulky mediastinal lymphadenopathy.<br /><br />She underwent endobronchial biopsy of the lung lesion, which demonstrated combined large cell neuroendocrine and small cell carcinoma. The case illustrates ectopic ACTH syndrome, a known paraneoplastic manifestation of small cell lung cancer that often presents insidiously and may be mistaken for more common causes of hypertension, diabetes, or hypokalemia. Hypokalemia is especially suggestive and more common in ectopic ACTH than pituitary causes.<br /><br />The patient attempted platinum-etoposide chemotherapy but could not tolerate treatment and ultimately chose hospice care, dying about two months after diagnosis. The report emphasizes that unexplained, resistant hypertension plus hyperglycemia and hypokalemia should prompt evaluation for Cushing syndrome, including ectopic ACTH production from an occult malignancy.

Asset Subtitle

Joshua D. Garcia

Meta Tag

Author List Hannah E. Dee, Joshua D. Garcia

Category Clinical Vignettes

Concept Cortisol Excess

Concept Ectopic ACTH

Concept ACTH

Concept Hypokalemia

Concept Cortisol

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Joshua D. Garcia

Track Adult

Keywords

ectopic ACTH syndrome

Cushing syndrome

small cell lung cancer

hypercortisolism

hypokalemia

hypertension

hyperglycemia

paraneoplastic syndrome

neuroendocrine carcinoma

metastatic disease

Cortisol Excess

Ectopic ACTH

ACTH

Hypokalemia

Cortisol