Question: A 63-year-old man with a past medical history of hypertension presented with increasing lower extremity edema, persistent hypokalemia, and back pain for >2 months. Despite administration of spironolactone together with intravenous and oral potassium supplement, his clinical symptoms progressed, prompting admission to our institution. Physical examination showed prominent bilateral pitting lower extremity edema up to his knees. Laboratory results showed potassium 2.9 mmol/L (normal, 3.5–5.3), Na+ 150 mmol/L (normal, 137–147), Ca2+ 1.89 mmol/L (normal, 2.1–2.6), alanine transaminase 145U/L, blood sugar 7.5 mmol/L, and lipase 110.8 U/L.