Endocrine Abstracts

Authors present a case report of the 25-year patient with suspicion of adrenal insufficiency (AI). Based on the clinical picture and plasma cortisol levels in low-dose 1 μg ACTH test (32.00–65.40 nmol/l, normal response >500 nmol/l) AI was confirmed. On ECG record was present deep s-wave in leads I, II, III, aVF, V5-V6 and rsŕ-shaped QRS complex in leads aVR and V1 – finding consistent with incomplete right bundle-branch block. Moreover horizontal elevation ST in V1, saddleback elevation in V2 and ascendent elevation in V3 were present.

Although mineral changes (hyperkalemia, hypercalcemia) which are typical findings in patients with untreated AI are possible causes of the ST-segment elevations, the pacient’s mineral levels were in normal values (K 4.0 mmol/l, Ca 2.45 mmol/l). Event in negative family and personal history regarding sudden cardiac death, arrhytmias or need for resuscitation the suspicion for Brugada syndrome (BS) was expressed. Ajmaline test (50 mg i.v. 10 mg/min.) was indicated and performed, in which saddleback ST-elevations (type 2) changed to typical pattern of elevations (type 1) patognomic for BS. Presently we are waiting for result of the molecular analysis of the gene coding SCN5A sodium channel. Mutations in this gene are at the present time the only underlying cause of malignant arrhytmias in patients with BS. This case presents urge for careful interdisciplinary endocrinological-cardiological differential diagnosis in evaluation of ECG changes in patients with endocrine disorders.