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Surgery MCQ 129

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A high prevalence of skin pigmentation, muscle weakness and hypokalemia is associated with which type of cushing syndrome:

A. Ectopic secretion of ACTH
B. ACTH secreting pituitary adenomas
C. Adrenal adenoma
D. Iatrogenic


The most likely type of Cushing's syndrome associated with a high prevalence of skin pigmentation, muscle weakness, and hypokalemia is:


A. Ectopic secretion of ACTH


Here's why:

  • Skin pigmentation: Ectopic ACTH secretion, often caused by tumors outside the pituitary gland (like lung cancer), tends to lead to more prominent and widespread skin pigmentation compared to other forms of Cushing's syndrome. This is thought to be due to higher levels and different patterns of ACTH secretion.

  • Muscle weakness: Ectopic ACTH secretion tends to cause more rapid and severe muscle weakness than other forms, possibly due to the additional effects of ACTH itself on muscle function.

  • Hypokalemia: High levels of cortisol associated with Cushing's syndrome can lead to potassium depletion (hypokalemia) through various mechanisms. However, ectopic ACTH secretion often involves ACTH variants with increased mineralocorticoid activity, which further promotes potassium loss, making hypokalemia more common in this type.


While other options can also exhibit these symptoms to some degree:


  • ACTH secreting pituitary adenomas (B): This type may present with similar features, but skin pigmentation might be less pronounced, and muscle weakness may develop more gradually.

  • Adrenal adenoma (C): This typically doesn't involve ACTH and therefore has a lower likelihood of severe muscle weakness and prominent pigmentation.

  • Iatrogenic (D): This refers to Cushing's caused by exogenous glucocorticoids (steroid medications). While muscle weakness and hypokalemia can occur, the pattern of skin pigmentation is usually different from ectopic ACTH secretion.

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