title: Hypophosphatemia as unusual cause of ARDS in Cushing's syndrome secondary to ectopic CRH production. A case report.
abstract: Hypophosphatemia is an unusual cause of acute respiratory distress syndrome (ARDS). We describe a hypophosphatemia-related ARDS case report of a 50-year-old woman with ACTH dependent Cushing's syndrome secondary to ectopic CRH production. The patient clinically showed hypotension tachypnea and increasing dyspnea. Laboratory data showed carbohydrate intolerance, severe hypokalemia, and hypophosphatemia. Arterial blood gases measurement revealed hypocapnia and elevation in bicarbonate values. Chest X-ray showed diffuse bilateral alveolar infiltrates similar to acute pulmonary edema and Kerley's striae. Chest CT scan evidenced diffuse ground glass opacification, bilateral patchy consolidation, and fibrosis, compatible with the recovery phase of ARDS. Clinical symptoms and laboratory examinations supported the diagnosis of ARDS. The patient was managed with supplemental potassium, octreotide, and oxygen therapy. Hypophosphatemia was managed by treating the underlying disorder. Successive surgical removal of the adrenal gland led to complete resolution of Cushing's syndrome. In conclusion, although rare and associated with specific risk factors, hypophosphatemia should be suspected in patients who develop unexplained ARDS.
authors.affiliation: Department of Internal Medicine, Psychiatric and Anesthesiological Sciences, University of Messina, School of Medicine, Policlinico Universitario G.Martino, 98125 Messina, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Mondello
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fodale
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cannavò
authors.forename: Carmela
authors.initials: C
authors.lastname: Aloisi
authors.forename: Barbara
authors.initials: B
authors.lastname: Almoto
authors.forename: Michele
authors.initials: M
authors.lastname: Buemi
authors.forename: Letterio B
authors.initials: LB
authors.lastname: Santamaria
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000150:complications* / Q000000981:diagnostic imaging; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D003480:Cushing Syndrome / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006729:Hormones, Ectopic / Q000378:metabolism; D006801:Humans; D017674:Hypophosphatemia / Q000150:complications*; D008875:Middle Aged; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000209:etiology*
chemical_list: D006729:Hormones, Ectopic; D003346:Corticotropin-Releasing Hormone