Abstract
A 61-year-old male patient with hypokalemia, acroedema and hyperglycaemia was referred to our endocrinology ward for recompensation and further diagnostic. The endocrine laboratory data showed an elevated ACTH-level, a nullified circadian rhythm of cortisol as well as no cortisol suppression after low-dose and high-dose dexamethasone suppression test. CRH stimulation revealed no significant increase in ACTH- and cortisol-levels. Abdominal ultrasound as well as endoscopic ultrasound showed a significant tumour mass in the head of the pancreas. Moreover, distinct lymphnode metastases surrounding the pancreatic head were described. Gene testing for typical MEN-1 gene mutations was negative. Therapeutically abdominal surgery with pylorus preserving pancreatic head resection was performed. The pathohistological examination of the tumour established the diagnosis of an ACTH-producing neuroendocrine carcinoma accompanied by multiple lymphnode metastases. Testing 12 weeks after surgery showed a normal circadian rhythm and suppression of cortisol after low dose dexamethasone. This case report demonstrates that hypokalemia could be a rare sign for Cushing's disease.
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