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Rare but serious cause for hypokalaemia and hypertension
  1. Hussun-Ara Shah1,2,
  2. Asgar Madathil3 and
  3. Charlotte Routh4
  1. 1Medical Education, Newcastle University, Newcastle upon Tyne, UK
  2. 2Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
  3. 3Diabetes and Endocrinology, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
  4. 4Acute Medicine, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
  1. Correspondence to Dr Hussun-Ara Shah; h.shah2{at}newcastle.ac.uk

Abstract

Adrenocortical carcinoma is a rare tumour but hypertension conversely is very common. We present the case of a woman in her 30s, with poorly controlled hypertension on four antihypertensive agents. She was referred to the accident and emergency department with hypokalaemia. For a year, she had experienced oedema, weight gain, acne, hirsutism and oligomenorrhea. She had a classic Cushingoid appearance and marked striae. Cushing’s syndrome was confirmed biochemically with an abnormal overnight dexamethasone suppression test. She was diagnosed with metastatic adrenocortical carcinoma following CT imaging. This was resected via a right adrenalectomy, nephrectomy and cholecystectomy. She also received mitotane. Unfortunately, she has a terminal prognosis having experienced a recurrence. This case demonstrates the value of a thorough clinical assessment. More importantly, it highlights the need to refer earlier patients under 40 with resistant hypertension to a specialist. Finally, it encourages clinicians to investigate hypokalaemia in the context of hypertension.

  • adrenal disorders
  • endocrine cancer
  • general practice / family medicine
  • hypertension
  • fluid electrolyte and acid-base disturbances

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Footnotes

  • Contributors H-AS is the first author of this case report and wrote up the case with feedback from CR and AM shaping the final version. All authors were involved in the patient’s care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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