Endocrine Abstracts

Patients with Cushing’s syndrome usually have characteristic phenotypical features but this is not always true in case of Ectopic ACTH secretion. This is mainly because this develops more acutely and underlying malignancy can cause significant weight loss. We report a 71 years old male with background of Prostatic malignancy who was found to have new profound hypokalaemia which was resistant to treatment. There were no signs of Cushing’s syndrome but index of suspicion was high given persistent hypokalaemia on background of known malignancy, metabolic alkalosis and hypertension. Random cortisol came significantly elevated which failed to supress after overnight 8 mg Dexamethasone suppression test. ACTH was significantly high. He was planned for medical management given progression of malignancy and was started on metyrapone which resolved the hypokalaemia. Unfortunately patient died within 2 months due to progression of underlying malignancy. It is important to recognise such cases of hypokalaemia early, to appropriately deal with excess cortisol production.