Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatu-ku, Kawasaki-shi, Kanagawa-ken, 213-0015, Japan.
J Clin Endocrinol Metab. 2013 Jan;98(1):13-9. doi: 10.1210/jc.2012-2766. Epub 2012 Nov 21.
Hyperkalemia and weight loss are critical clinical problems for hemodialysis patients. There have been no documented reports of adrenal Cushing's syndrome with central obesity and hypokalemia in a hemodialysis patient.
The aim of the study was to report a patient with Cushing's syndrome after chronic hemodialysis, review the published literature, and discuss the significance of hypokalemia and obesity in anuric hemodialysis patients from the perspective of cortisol metabolism.
A 61-yr-old woman who had been on hemodialysis for 21 yr presented with persistent hypokalemia and central obesity. In 2002, her dry weight was 48.1 kg, but thereafter she gained weight to 60 kg.
Adrenal Cushing's syndrome was diagnosed from endocrinological findings such as increased cortisol secretion without a circadian rhythm and suppression of plasma ACTH. Spironolactone was administered (25 to 50 mg/d), and her serum potassium became normal. Then, left adrenalectomy was performed by laparoscopic surgery. The resected specimen contained a well-circumscribed adrenal adenoma expressing P450c17. After surgery, hypokalemia improved gradually without medication, and her weight gain stopped.
This is the first documented case of adrenal Cushing's syndrome in a patient on long-term hemodialysis, although several authors have reported a relation between hypokalemia and primary hyperaldosteronism in hemodialysis patients.
高钾血症和体重减轻是血液透析患者的严重临床问题。目前尚无文献报道血液透析患者存在库欣综合征伴中心性肥胖和低钾血症。
本研究旨在报告 1 例慢性血液透析后发生库欣综合征的患者，复习已发表的文献，并从皮质醇代谢的角度讨论无尿血液透析患者低钾血症和肥胖的意义。
1 例 61 岁女性，血液透析 21 年，持续性低钾血症和中心性肥胖。2002 年，其干体重为 48.1kg，但此后体重增加至 60kg。
内分泌学检查发现皮质醇分泌增加，无昼夜节律，ACTH 受抑制，诊断为库欣综合征。给予螺内酯（25~50mg/d）治疗，血钾恢复正常。随后，行腹腔镜左肾上腺切除术。切除标本中含有边界清楚的表达 P450c17 的肾上腺腺瘤。术后低钾血症逐渐改善，无需药物治疗，体重增加停止。
这是首例长期血液透析患者发生肾上腺库欣综合征的报道，尽管已有作者报道血液透析患者低钾血症与原发性醛固酮增多症有关。
