<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2312-3893</journal-id>
<journal-title><![CDATA[Revista Virtual de la Sociedad Paraguaya de Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. virtual Soc. Parag. Med. Int.]]></abbrev-journal-title>
<issn>2312-3893</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2312-38932026000100307</article-id>
<article-id pub-id-type="doi">10.18004/rvspmi/2312-3893/2026.e13142607</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Hipokalemia severa refractaria como manifestación inicial de enfermedad de Cushing]]></article-title>
<article-title xml:lang="en"><![CDATA[Severe refractory hypokalemia as an initial manifestation of Cushing's disease]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rolón Ramírez]]></surname>
<given-names><![CDATA[Rudy Rancell]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Méndez Fernández]]></surname>
<given-names><![CDATA[Cecilia Rosmary]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cano González]]></surname>
<given-names><![CDATA[Jorge Luis]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Asunción Facultad de Ciencias Médicas Hospital de Clínicas]]></institution>
<addr-line><![CDATA[San Lorenzo ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<volume>13</volume>
<numero>1</numero>
<fpage>307</fpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2312-38932026000100307&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2312-38932026000100307&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2312-38932026000100307&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN El síndrome de Cushing se produce por exceso de glucocorticoides, ya sea por causas exógenas o endógenas. La enfermedad de Cushing corresponde a la forma ACTH dependiente secundaria a adenomas hipofisarios. Se presenta el caso de un varón de 31 años, previamente sano, que consultó por un mes de parestesias progresivas y cifras tensionales elevadas. En la evaluación inicial se evidenció hipokalemia severa (1,9 mEq/L) refractaria a reposiciones, lo que motivó estudios complementarios. Los resultados mostraron cortisol AM elevado (49,82 µg/dL) y ACTH aumentada (55,5 pg/mL), con adecuada supresión tras la prueba de Liddle, confirmando hipercortisolismo ACTH dependiente. La resonancia magnética de encéfalo reveló dos microadenomas hipofisarios, compatibles con enfermedad de Cushing. El paciente fue derivado a neurocirugía para resección transesfenoidal. Este caso ilustra la hipokalemia severa como manifestación inicial de la enfermedad de Cushing, un hallazgo poco común que resalta la importancia de considerar el hipercortisolismo en el diagnóstico diferencial de las alteraciones hidroelectrolíticas refractarias. Además, constituye un aporte local relevante, dado que en Paraguay no se registran reportes previos de esta forma de presentación.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Cushing's syndrome is caused by excess glucocorticoids, either due to exogenous or endogenous causes. Cushing's disease corresponds to the ACTH-dependent form secondary to pituitary adenomas. We present the case of a 31-year-old man, previously healthy, who consulted for a month of progressive paresthesias and high blood pressure. The initial evaluation revealed severe hypokalemia (1.9 mEq/L) refractory to replacement therapy, which prompted further studies. The results showed elevated AM cortisol (49.82 µg/dL) and increased ACTH (55.5 pg/mL), with adequate suppression after the Liddle test, confirming ACTH-dependent hypercortisolism. Brain MRI revealed two pituitary microadenomas, consistent with Cushing's disease. The patient was referred to neurosurgery for transsphenoidal resection. This case illustrates severe hypokalemia as an initial manifestation of Cushing's disease, an uncommon finding that highlights the importance of considering hypercortisolism in the differential diagnosis of refractory electrolyte disturbances. Furthermore, it constitutes a relevant local contribution, given that there are no previous reports of this form of presentation in Paraguay.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[hipokalemia]]></kwd>
<kwd lng="es"><![CDATA[síndrome de Cushing]]></kwd>
<kwd lng="es"><![CDATA[neoplasias hipofisarias]]></kwd>
<kwd lng="en"><![CDATA[hypokalemia]]></kwd>
<kwd lng="en"><![CDATA[Cushing syndrome]]></kwd>
<kwd lng="en"><![CDATA[pituitary neoplasms]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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