| Ectopic ACTH syndrome revealed as severe hypokalemia and persistent hypertension during the perioperative period: a case report. | |
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MedLine Citation:
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PMID: 21052735 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Both severe hypokalemia and persistent hypertension are clinical symptoms of hyperaldosteronism. Hyperaldosteronism may occur as a primary or secondary syndrome. Excess ACTH produced ectopically by tumors may induce hyperaldosteronism through the mineralocorticoid activity of glucocorticoids that are upregulated by ACTH. Licorice, with the active ingredient glycyrrhiza, is also a well-known inducer of hyperaldosteronism under specific conditions. In this report, we describe a case of severe hypokalemia caused by ectopic ACTH syndrome (EAS) elicited by an intrathoracic carcinoid tumor, which had transformed to produce ACTH during the 6-year clinical course, and was modulated by licorice ingestion. Hypokalemia was not clearly recognized preoperatively but became obvious within 3 h of general anesthesia with epidural blockade. At the end of anesthesia, arterial blood gas analysis indicated severe hypokalemia ([K(+)] = 1.7 mEq/l) and metabolic alkalosis (pH 7.56, PaCO(2) = 54.9 mmHg, HCO(3) (-) = 44.5 mmol/l, BE = 21.8 mmol/l), without any typical symptoms such as muscle weakness or ECG abnormalities. The hypokalemia was resistant to potassium supplementation and persisted for 4 days. Perioperative imbalance between the administration and elimination of potassium and surgical stress might contribute to the rapid exacerbation and induce the clinical manifestation of EAS. |
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Authors:
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Shun Kishimoto; Kiichi Hirota; Hajime Segawa; Kazuhiko Fukuda |
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Publication Detail:
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Type: Journal Article Date: 2010-11-04 |
Journal Detail:
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Title: Journal of anesthesia Volume: 25 ISSN: 1438-8359 ISO Abbreviation: J Anesth Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-02-17 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8905667 Medline TA: J Anesth Country: Japan |
Other Details:
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Languages: eng Pagination: 104-7 Citation Subset: IM |
Affiliation:
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Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, 606-8507, Japan. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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