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These clinical findings and refractory hypokalaemic hypertension with metabolic alkalosis raised a suspicion of Cushing\u2019s syndrome (CS). 24-hour urinary free cortisol (24 hours) was grossly raised on two occasions. The adrenocorticotropic hormone (ACTH) was significantly raised at 154\u2009ng\/L, confirming ACTH-dependant CS. A CT scan of the thorax, abdomen and pelvis excluded an ectopic source of hypercortisolaemia. MRI pituitary revealed an invasive macroadenoma. Treatment with endoscopic debulking resulted in the resolution of hypokalaemia and metabolic alkalosis with significant improvement in hyperglycaemia and hypertension.<\/jats:p>","DOI":"10.1136\/bcr-2021-244850","type":"journal-article","created":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T12:46:26Z","timestamp":1629981986000},"page":"e244850","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Refractory hypokalaemia and hypertension with metabolic alkalosis: an acute presentation of Cushing\u2019s disease secondary to a pituitary macroadenoma"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8946-4255","authenticated-orcid":false,"given":"Najeeb Zaheer","family":"Shah","sequence":"first","affiliation":[{"name":"Diabetes and Endocrinology, Hull University Teaching Hospitals NHS Trust, Hull, UK"},{"name":"Department of Academic Diabetes, Endocrinology and Metabolism, University of Hull, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shah","family":"Malik","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology, Hull University Teaching Hospitals NHS Trust, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thozhukat","family":"Sathyapalan","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology, Hull University Teaching Hospitals NHS Trust, Hull, UK"},{"name":"Department of Academic Diabetes, Endocrinology and Metabolism, University of Hull, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamrudeen","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrinology, Hull University Teaching Hospitals NHS Trust, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,26]]},"reference":[{"key":"2025082703572342000_14.8.e244850.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68699-6"},{"key":"2025082703572342000_14.8.e244850.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1994.tb02486.x"},{"key":"2025082703572342000_14.8.e244850.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2009.06.001"},{"key":"2025082703572342000_14.8.e244850.4","doi-asserted-by":"crossref","first-page":"46","DOI":"10.3346\/jkms.2009.24.1.46","article-title":"Comparisons between macroadenomas and microadenomas in Cushing's disease: characteristics of hormone secretion and clinical outcomes","volume":"24","author":"Hwang","year":"2009","journal-title":"J Korean Med Sci"},{"key":"2025082703572342000_14.8.e244850.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2002.tb04419.x"},{"key":"2025082703572342000_14.8.e244850.6","unstructured":"National Center for Biotechnology Information . 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