caa a22 4500 445372966 CHVBK 20180317142953.0 cr unu---uuuuu 170323e20110201xx s 000 0 eng 10.1007/s00540-010-1041-z doi (NATIONALLICENCE)springer-10.1007/s00540-010-1041-z Ectopic ACTH syndrome revealed as severe hypokalemia and persistent hypertension during the perioperative period: a case report [Elektronische Daten] [Shun Kishimoto, Kiichi Hirota, Hajime Segawa, Kazuhiko Fukuda] Both severe hypokalemia and persistent hypertension are clinical symptoms of hyperaldosteronism. Hyperaldosteronism may occur as a primary or secondary syndrome. Excess ACTH produced ectopically by tumors may induce hyperaldosteronism through the mineralocorticoid activity of glucocorticoids that are upregulated by ACTH. Licorice, with the active ingredient glycyrrhiza, is also a well-known inducer of hyperaldosteronism under specific conditions. In this report, we describe a case of severe hypokalemia caused by ectopic ACTH syndrome (EAS) elicited by an intrathoracic carcinoid tumor, which had transformed to produce ACTH during the 6-year clinical course, and was modulated by licorice ingestion. Hypokalemia was not clearly recognized preoperatively but became obvious within 3h of general anesthesia with epidural blockade. At the end of anesthesia, arterial blood gas analysis indicated severe hypokalemia ([K+]=1.7mEq/l) and metabolic alkalosis (pH 7.56, PaCO2=54.9mmHg, HCO3 −=44.5mmol/l, BE=21.8mmol/l), without any typical symptoms such as muscle weakness or ECG abnormalities. The hypokalemia was resistant to potassium supplementation and persisted for 4days. Perioperative imbalance between the administration and elimination of potassium and surgical stress might contribute to the rapid exacerbation and induce the clinical manifestation of EAS. Japanese Society of Anesthesiologists, 2010 Hypokalemia nationallicence Ectopic ACTH syndrome nationallicence Cushing's syndrome nationallicence Licorice nationallicence Perioperative period nationallicence Kishimoto Shun Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawaracho, Sakyo-ku, 606-8507, Kyoto, Japan aut Hirota Kiichi Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawaracho, Sakyo-ku, 606-8507, Kyoto, Japan aut Segawa Hajime Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawaracho, Sakyo-ku, 606-8507, Kyoto, Japan aut Fukuda Kazuhiko Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawaracho, Sakyo-ku, 606-8507, Kyoto, Japan aut Journal of Anesthesia Springer Japan 25/1(2011-02-01), 104-107 0913-8668 25:1<104 2011 25 540 https://doi.org/10.1007/s00540-010-1041-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00540-010-1041-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kishimoto Shun Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawaracho, Sakyo-ku, 606-8507, Kyoto, Japan aut NATIONALLICENCE 700 1- Hirota Kiichi Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawaracho, Sakyo-ku, 606-8507, Kyoto, Japan aut NATIONALLICENCE 700 1- Segawa Hajime Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawaracho, Sakyo-ku, 606-8507, Kyoto, Japan aut NATIONALLICENCE 700 1- Fukuda Kazuhiko Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawaracho, Sakyo-ku, 606-8507, Kyoto, Japan aut NATIONALLICENCE 773 0- Journal of Anesthesia Springer Japan 25/1(2011-02-01), 104-107 0913-8668 25:1<104 2011 25 540 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer