Mineralocorticoid Effects in Cushing's Disease: A Case Report

Cushing's syndrome is a rare disease caused due to prolonged exposure to excess glucocorticoids. Although rare, diagnosing Cushing's syndrome is clinically significant as it allows tailored and timely management and significant reduction or even prevention of the comorbidities caused by cortisol excess. This report delineates the presentation of a 44-year-old female with refractory secondary hypertension and severe hypokalaemia, initially thought to be caused by hyperaldosteronism. Upon a more careful physical examination, the presence of moon facies, acanthosis nigricans and violaceous abdominal striae raised suspicion of hypercortisolism. Laboratory tests confirmed the suspicion with increased cortisol and adrenocorticotropic hormone (ACTH) levels. Furthermore, imaging findings led to the final diagnosis of Cushing's disease due to an ACTH-secreting pituitary macroadenoma. The patient underwent successful transsphenoidal surgery, resulting in substantial clinical improvement, evidenced by significant weight loss and hypertension with decreased need for drugs. When left untreated, patients with Cushing's disease have a higher mortality rate than the general population. This case underscores the critical importance of keeping in mind secondary endocrine causes in the context of resistant hypertension especially with complex metabolic disturbances and recognizing the most characteristic features of this disease.