Abrupt Weight Gain, Hypertension, and Severe Hypokalemia in a Young Male

Cushing’s syndrome (CS) can be difficult to differentiate from metabolic syndrome and obesity, and increased awareness is needed. More specific signs of disease result from the underlying catabolic state of hypercortisolism. When adrenocorticotropic hormone (ACTH)-dependent CS is confirmed, a next step is localization of ACTH excess, which is achieved with pituitary imaging and inferior petrosal sinus sampling. For patients who have ectopic CS, chest and abdomen computed tomography/magnetic resonance imaging and functional imaging can be undertaken. However, in a few cases, a tumor is not discovered. If a patient is experiencing rapid clinical deterioration, treatment with medical therapy and/or bilateral adrenalectomy should be prioritized over etiologic or localization workup. Risk of complications, including infections and cardiovascular and deep vein thrombosis, should be acknowledged. Complication prevention and management should be instituted promptly in all CS patients, particularly for those who have severe CS and hence a higher mortality risk.