{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T06:14:39Z","timestamp":1757312079787,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,1,21]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>Adrenocortical carcinoma is a rare tumour but hypertension conversely is very common. We present the case of a woman in her 30s, with poorly controlled hypertension on four antihypertensive agents. She was referred to the accident and emergency department with hypokalaemia. For a year, she had experienced oedema, weight gain, acne, hirsutism and oligomenorrhea. She had a classic Cushingoid appearance and marked striae. Cushing\u2019s syndrome was confirmed biochemically with an abnormal overnight dexamethasone suppression test. She was diagnosed with metastatic adrenocortical carcinoma following CT imaging. This was resected via a right adrenalectomy, nephrectomy and cholecystectomy. She also received mitotane. Unfortunately, she has a terminal prognosis having experienced a recurrence. This case demonstrates the value of a thorough clinical assessment. More importantly, it highlights the need to refer earlier patients under 40 with resistant hypertension to a specialist. Finally, it encourages clinicians to investigate hypokalaemia in the context of hypertension.<\/jats:p>","DOI":"10.1136\/bcr-2020-239955","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T13:38:52Z","timestamp":1614951532000},"page":"e239955","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Rare but serious cause for hypokalaemia and hypertension"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2876-4056","authenticated-orcid":false,"given":"Hussun-Ara","family":"Shah","sequence":"first","affiliation":[{"name":"Medical Education, Newcastle University, Newcastle upon Tyne, UK"},{"name":"Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asgar","family":"Madathil","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Routh","sequence":"additional","affiliation":[{"name":"Acute Medicine, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"2025082710042715000_14.3.e239955.1","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1016\/j.annonc.2020.08.2099","article-title":"Adrenocortical carcinomas and malignant phaeochromocytomas: ESMO-EURACAN clinical practice guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Fassnacht","year":"2020","journal-title":"Ann Oncol"},{"key":"2025082710042715000_14.3.e239955.2","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-18-0608","article-title":"European Society of endocrinology clinical practice guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European network for the study of adrenal tumors","volume":"179","author":"Fassnacht","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"2025082710042715000_14.3.e239955.3","doi-asserted-by":"publisher","DOI":"10.1210\/er.2013-1029"},{"key":"2025082710042715000_14.3.e239955.4","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1111\/j.1524-6175.2003.02833.x","article-title":"Adrenal carcinoma","volume":"5","author":"Handler","year":"2003","journal-title":"J Clin Hypertens"},{"key":"2025082710042715000_14.3.e239955.5","doi-asserted-by":"crossref","DOI":"10.1186\/1756-0500-6-405","article-title":"Adrenocortical carcinoma initially presenting with hypokalemia and hypertension mimicking hyperaldosteronism: a case report","volume":"6","author":"Huang","year":"2013","journal-title":"BMC Res Notes"},{"key":"2025082710042715000_14.3.e239955.6","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1038\/sj.jhh.1001105","article-title":"Two cases of adrenocortical carcinoma presenting as Conn's syndrome","volume":"15","author":"Dixon","year":"2001","journal-title":"J Hum Hypertens"},{"key":"2025082710042715000_14.3.e239955.7","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2016-217918","article-title":"Adrenocortical carcinoma, an unusual cause of secondary hypertension","volume":"2016","author":"Veron Esquivel","year":"2016","journal-title":"BMJ Case Rep"},{"key":"2025082710042715000_14.3.e239955.8","unstructured":"National Statistics . Health Survey for England 2018 Adults\u2019 Health Report, 2019. Available: https:\/\/files.digital.nhs.uk\/E4\/DAA235\/HSE18-Adult-Health-rep.pdf"},{"key":"2025082710042715000_14.3.e239955.9","unstructured":"National Institute for Health and Care Excellence . Hypertension in adults and management, 2019. Available: https:\/\/www.nice.org.uk\/guidance\/ng136"},{"key":"2025082710042715000_14.3.e239955.10","doi-asserted-by":"crossref","DOI":"10.1136\/pmj.79.934.466","article-title":"Cushing's syndrome due to an adrenocortical carcinoma","volume":"79","author":"Nag","year":"2003","journal-title":"Postgrad Med J"},{"key":"2025082710042715000_14.3.e239955.11","first-page":"227","article-title":"A woman with long-standing hypertension diagnosed with metastatic adrenal carcinoma","volume":"7","author":"Alikhan","year":"2007","journal-title":"Journal of Applied Research"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239955","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:04:34Z","timestamp":1756314274000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239955"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,4]]},"published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1136\/bcr-2020-239955"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239955","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}