Resumen

ROLON RAMIREZ, Rudy Rancell; MENDEZ FERNANDEZ, Cecilia Rosmary  y  CANO GONZALEZ, Jorge Luis. Severe refractory hypokalemia as an initial manifestation of Cushing's disease. Rev. virtual Soc. Parag. Med. Int. [online]. 2026, vol.13, n.1, e13142607.  Epub 21-Feb-2026. ISSN 2312-3893.  https://doi.org/10.18004/rvspmi/2312-3893/2026.e13142607.

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.

Palabras clave : hypokalemia; Cushing syndrome; pituitary neoplasms.

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