# Unveiling the Uncommon: Cushing’s Syndrome (CS) Masquerading as Severe Hypokalemia

## TL;DR

A rare case of Cushing's syndrome presented as severe low potassium, highlighting unusual symptoms and the need for thorough diagnosis.

## Contribution

This case report highlights an uncommon presentation of Cushing’s syndrome as severe hypokalemia, emphasizing diagnostic challenges.

## Key findings

- A 48-year-old male presented with severe hypokalemia as the primary symptom of Cushing’s syndrome.
- Diagnostic tests confirmed hypercortisolism and identified a pituitary macroadenoma requiring surgery.
- The case illustrates the importance of considering rare presentations of Cushing’s syndrome in differential diagnosis.

## Abstract

Cushing's syndrome (CS) arises from an excess of endogenous or exogenous cortisol, with Cushing's disease specifically implicating a pituitary adenoma and exaggerated adrenocorticotropic hormone (ACTH) production. Typically, Cushing's disease presents with characteristic symptoms such as weight gain, central obesity, moon face, and buffalo hump.

This case report presents an unusual manifestation of CS in a 48-year-old male with a history of hypertension, where severe hypokalemia was the primary presentation. Initial complaints included bilateral leg swelling, muscle weakness, occasional shortness of breath, and a general feeling of not feeling well. Subsequent investigations revealed hypokalemia, metabolic alkalosis, and an abnormal response to dexamethasone suppression, raising concerns about hypercortisolism. Further tests, including 24-hour urinary free cortisol and ACTH testing, confirmed significant elevations. Brain magnetic resonance imaging (MRI) identified a pituitary macroadenoma, necessitating neurosurgical intervention.

This case underscores the rarity of CS presenting with severe hypokalemia, highlighting the diagnostic challenges and the crucial role of a collaborative approach in managing such intricate cases.