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Cyclical Edema and Hypokalemia due to Occult Episodic Hypercorticism^*

Hôtel-Dieu Hospital, Clinical Research Institute of Montreal, and Uniuersité de Montréal Montreal, Quebec, Canada

Address all correspondence and requests for reprints to: Otto Kuchel, M.D., Clinical Research Institute of Montreal, 110 Pine Avenue West, Montreal, Quebec, H2W 1R7 Canada.

Yearly episodes of edema, hypokalemia, anxiety, and depression were found to be due to cortisol and deoxycorti-costerone surges secondary to a pituitary adenoma in a woman without any of the usual clinical features of Cushing’s syndrome. During the long clinical remissions, she had no recognizable laboratory abnormality. She had two episodes in the year following incomplete transphenoidal pituitary tumor resection, but has had none in 2 yr since receiving radiotherapy. The episodes were caused by mineralocorticoid actions of large ACTH-induced increases in cortisol and deoxycorticosterone secretion. A history of episodic edema and hypokalemia, often attributed in women to surreptitious diuretic abuse, requires a careful search for hypercorticism even in the absence of clinical Cushing’s syndrome.

^* This work was supported by grants from the MRC of Canada and the Canadian Kidney Foundation.

Received June 17, 1986.

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