The hypokalemic prelude: A Pandora’s box of paraneoplastic surprises

ABSTRACT Ectopic adrenocorticotropic hormone (ACTH) syndrome is a rare paraneoplastic manifestation, particularly in gynecological malignancies. We present the case of a 39-year-old female with a history of small-cell cervical carcinoma who presented to us with fatigue and tiredness and was diagnosed to have severe hypokalemia secondary to Cushing’s syndrome due to production of ectopic ACTH. This case highlights the importance of recognizing atypical presentations of metastatic disease and the challenges in diagnosis and management of paraneoplastic endocrine syndromes.