discussion-presentation84

              IN THE NAME OF ALLAH

                    shahin nosratzehi

• manifestations of glucocorticoid excess were rapid and progressive
• Weight loss
• myopathy
• and glucose intolerance are prominent symptoms and signs.
• Hypokalemic metabolic alkalosis (EAS patients 90% vs. 10 - 15% in CD)
• ACTH levels in the ectopic ACTH syndrome are high (usually >20 pmol/L [>90 pg/mL]); nevertheless, overlap values are seen in CD in 30% of cases.

• A 62-year-old man with a past medical history of obesity and HTN, without any previous medication

• was admitted to the emergency department With
•  altered mental status, polyuria, polydipsia
• irritability
• easy bruising
• and proximal muscle weakness of sudden onset. (1 month prior)

• physical examination

• slight dehydration, obesity (BMI:31.2 kg/m2)
• moon face, echymoses on the upper limbs
• proximal muscle weakness
• There was no peripheral edema, striae
• At admission, plasma glucose was 452 mg/dL (25 mmol/L), serum potassium 2.7 mmol/L, arterial pH 7.6, and bicarbonate 50 mmol/

• cranial magnetic resonance imaging (MRI) was performed:

•  a right-sided sellar expansive lesion with suprasellar and right cavernous sinus extension measuring 22 mm maximum diameter

• The patient underwent endoscopic transsphenoidal tumor excision, with pre-operative preparation with metyrapone.