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Diagnosis and Treatment > Medication

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Katta Sai Department of Internal Medicine, Saint Vincent Hospital at Worcester Medical Center, Worcester, Massachusetts, USA

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Amos Lal Department of Internal Medicine, Saint Vincent Hospital at Worcester Medical Center, Worcester, Massachusetts, USA

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Jhansi Lakshmi Maradana Department of Internal Medicine, Saint Vincent Hospital at Worcester Medical Center, Worcester, Massachusetts, USA

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Pruthvi Raj Velamala Department of Internal Medicine, Saint Vincent Hospital at Worcester Medical Center, Worcester, Massachusetts, USA

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Trivedi Nitin Department of Endocrinology, Diabetes, and Metabolism, Saint Vincent Hospital at Worcester Medical Center, Worcester, Massachusetts, USA

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Summary

Mifepristone is a promising option for the management of hypercortisolism associated with hyperglycemia. However, its use may result in serious electrolyte imbalances, especially during dose escalation. In our patient with adrenocorticotropic hormone-independent macro-nodular adrenal hyperplasia, unilateral adrenalectomy resulted in biochemical and clinical improvement, but subclinical hypercortisolism persisted following adrenalectomy. She was started on mifepristone. Unfortunately, she missed her follow-up appointments following dosage escalation and required hospitalization at an intensive care level for severe refractory hypokalemia.

Learning points:

Taxonomy:
Clinical Overview, Gland/Organ, Adrenal, Topic, Adrenal, Hormone, ACTH, Cortisol, DHEA, TSH, Condition/ Syndrome, Adrenocortical adenoma, Cushing's syndrome, Diabetes mellitus type 2, Hyperglycaemia, Hypokalaemia, Macronodular Adrenal Hyperplasia, Patient Demographics, Age, Adult, Gender, Female, Ethnicity, White, Country of Treatment, United States, Diagnosis and Treatment, Signs and Symptoms, Diabetes mellitus type 2, Hypokalaemia, Metabolic alkalosis, Pneumonia, Ventricular hypertrophy, Weight gain, Investigation, ACTH, Adrenal venous sampling, Brain natriuretic peptide, Cortisol (9am), Creatine kinase, CT scan, Dexamethasone suppression, Dexamethasone suppression (low dose), DHEA Sulphate, Echocardiogram, Haemoglobin A1c, Magnesium, Phosphate (serum), Potassium, TSH, X-ray, Intervention, Adrenalectomy, Medication, Dexamethasone, Diuretics, Insulin glargine, Metformin, Potassium chloride, Publication Details, Case Report Type, Unusual effects of medical treatment
DOI:
https://doi.org/10.1530/EDM-19-0064
Volume/Issue:
Volume 2019: Issue 1
Open access