TY - JOUR
T1 - Cushing's syndrome after hemodialysis for 21 years
AU - Mise, Koki
AU - Ubara, Yoshifumi
AU - Sumida, Keiichi
AU - Hiramatsu, Rikako
AU - Hasegawa, Eiko
AU - Yamanouchi, Masayuki
AU - Hayami, Noriko
AU - Suwabe, Tatsuya
AU - Hoshino, Junichi
AU - Sawa, Naoki
AU - Hashimoto, Masaji
AU - Fujii, Takeshi
AU - Sasano, Hironobu
AU - Takaichi, Kenmei
PY - 2013/1
Y1 - 2013/1
N2 - Context: Hyperkalemia and weight loss are critical clinical problems for hemodialysis patients. There have been no documented reports of adrenal Cushing's syndrome with central obesity and hypokalemia in a hemodialysis patient. Objective: The aim of the study was to report a patient with Cushing's syndrome after chronic hemodialysis, review the published literature, and discuss the significance of hypokalemia and obesity in anuric hemodialysis patients from the perspective of cortisol metabolism. Patient: A 61-yr-old woman who had been on hemodialysis for 21 yr presented with persistent hypokalemia and central obesity. In 2002, her dry weight was 48.1 kg, but thereafter she gained weight to 60 kg. Results: Adrenal Cushing's syndrome was diagnosed from endocrinological findings such as increased cortisol secretion without a circadian rhythm and suppression of plasma ACTH. Spironolactone was administered (25 to 50 mg/d), and her serum potassium became normal. Then, left adrenalectomy was performed by laparoscopic surgery. The resected specimen contained a well-circumscribed adrenal adenoma expressing P450c17. After surgery, hypokalemia improved gradually without medication, and her weight gain stopped. Conclusions: This is the firstdocumentedcase of adrenal Cushing'ssyndromein a patientonlong-term hemodialysis, although several authors have reported a relation between hypokalemia and primary hyperaldosteronism in hemodialysis patients.
AB - Context: Hyperkalemia and weight loss are critical clinical problems for hemodialysis patients. There have been no documented reports of adrenal Cushing's syndrome with central obesity and hypokalemia in a hemodialysis patient. Objective: The aim of the study was to report a patient with Cushing's syndrome after chronic hemodialysis, review the published literature, and discuss the significance of hypokalemia and obesity in anuric hemodialysis patients from the perspective of cortisol metabolism. Patient: A 61-yr-old woman who had been on hemodialysis for 21 yr presented with persistent hypokalemia and central obesity. In 2002, her dry weight was 48.1 kg, but thereafter she gained weight to 60 kg. Results: Adrenal Cushing's syndrome was diagnosed from endocrinological findings such as increased cortisol secretion without a circadian rhythm and suppression of plasma ACTH. Spironolactone was administered (25 to 50 mg/d), and her serum potassium became normal. Then, left adrenalectomy was performed by laparoscopic surgery. The resected specimen contained a well-circumscribed adrenal adenoma expressing P450c17. After surgery, hypokalemia improved gradually without medication, and her weight gain stopped. Conclusions: This is the firstdocumentedcase of adrenal Cushing'ssyndromein a patientonlong-term hemodialysis, although several authors have reported a relation between hypokalemia and primary hyperaldosteronism in hemodialysis patients.
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U2 - 10.1210/jc.2012-2766
DO - 10.1210/jc.2012-2766
M3 - Article
C2 - 23175690
AN - SCOPUS:84872064646
VL - 98
SP - 13
EP - 19
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 1
ER -