HYPERKALEMIA IN ACUTE-LEUKEMIA - A SIGN OF ADRENOCORTICAL INSUFFICIENCY

Objectives. To evaluate adrenal cortical reserve function in hyperkala emic patients with acute leukaemia (AL). Design. In hyperkalaemic AL p atients, after basal blood collection for cortisol, rapid adrenocortic otropic hormone (ACTH) stimulation test was performed with human a(1-2 4)-ACTH 0.25 mg, intravenously. Sixty minutes following injection, add itional plasma was obtained for cortisol. Normal response was a peak c ortisol level greater than 15 mu g dL(-1) with an increment greater th an 5 mu g dL(-1). Setting. Hacettepe University Hospital, Ankara, Turk ey. Subjects. Newly diagnosed AL patients with plasma K+ values exceed ing 4.5 mmol L-1, who had never received antileukaemia therapy were el igible for entry into the trial. Thirteen patients fulfilled these cri teria. Twenty AL patients with normal serum K+ levels were studied as controls. Results. In six patients with hyperkalaemia, adrenal cortica l response to rapid ACTH test was inadequate. One patient died during induction chemotherapy due to sepsis. Five of the remaining patients e ntered remission. Repeat ACTH tests during remission revealed normaliz ation of the adrenocortical function in these patients. However, in on ly one patient with normal serum K+ level, adrenocortical reserve was decreased. Conclusions. We suggest that in any AL patient with hyperka laemia, adrenal reserve function should be evaluated with rapid ACTH s timulation test. In states of resistant hypotension and hyperkalaemia, steroids may be life saving.