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Pancreatic Neuroendocrine Tumor Presenting as a Cushing’s Syndrome Associated with Hypertension

Abstract

Chinedu Ivonye, Ebere Okeke, Rohan Mankikar and Jolene Lowery

A young female was evaluated in the emergency department (ED) for persistent headache and fatigue one week after being started on antihypertensive therapy with poor response. Her medications were Amlodipine 10 mg daily, Hydrochlorothiazide 25 mg daily, Atenolol 100 mg daily and Hydralazine 50 mg three times daily. Further evaluation revealed cushingoid appearance, her blood pressure was 171/100 mmHg despite compliance with multiple antihypertensive therapy. Her clinical manisfestation prompted the evaluation for secondary causes of hypertension with laboratory evidence of hypokalemia, hyperglycemia, hypercortisolism with high ACTH that did not respond to low and high dose dexamethasone suppression. A splice mutation in MEN 1gene was found with the eventual diagnosis of metastatic pancreatic neuroendocrine tumor. Her turbulent course unravels how complex medical problems continue to masquerade as general medical ailments.