title: Cushing's syndrome after hemodialysis for 21 years.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatu-ku, Kawasaki-shi, Kanagawa-ken, 213-0015, Japan. kokimise@yahoo.co.jp
authors.forename: Koki
authors.initials: K
authors.lastname: Mise
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.forename: Rikako
authors.initials: R
authors.lastname: Hiramatsu
authors.forename: Eiko
authors.initials: E
authors.lastname: Hasegawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamanouchi
authors.forename: Noriko
authors.initials: N
authors.lastname: Hayami
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.forename: Masaji
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fujii
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
mesh_terms: D003480:Cushing Syndrome / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000209:etiology; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy*; D013997:Time Factors