ECE2018 Poster Presentations: Pituitary and Neuroendocrinology Clinical case reports - Pituitary/Adrenal (38 abstracts)
Prolonged QT intervals in a patient with empty sella and isolated ACTH deficiency.
Julia Silva-Fernández 1 , Francisco Javier Gómez-Alfonso 1 , Virgilio Martínez-Mateo 2 , Florentino Del Val-Zaballos 1 , Belvis Torres-Arroyo 1 , Paloma González-Lázaro 1 , Cristina Contreras-Pascual 1 , Rafael García-Ruiz 3 , Álvaro García-Manzanares Vázquez de Agredos 1 & Inés Gómez-García 1
1Sección de Endocrinología y Nutrición.Hospital Mancha Centro, Alcázar de San Juan, Spain; 2Sección de Cardiología. Hospital Mancha Centro., Alcázar de San Juan, Spain; 3Sección Neurología. Hospital Mancha Centro., Alcázar de San Juan, Spain.
Introduction: Adrenal crisis is a life-threatening emergency, however, the relation between adrenal crisis and life-threatening arrhythmia is not known. We describe the case of a patient with adrenal crisis and arrhythmia with prolongation of QT interval.
Case report: A 56-year-old woman was admitted to our hospital because of syncope. She reported having had similar episodes in the last year. She had no previous diagnoses and was not receiving any treatment. She presented at the emergency department with new episodes of syncope and depressed level of consciousness. The ECG strip showed prolongation of QT interval and the ECG monitoring registered polymorphic VT (Torsade de Pointes), so the patient was referred to the intensive care unit. On physical examination, her palpebral conjunctiva was pale, and her skin and her tongue were not pigmented. Routine blood examination revealed hyponatremia (126 mEq/L) and hyperkalemia (5.7 mEq/L) with low glucose levels. Fluid therapy with a dextrose solution was necessary to maintain normal glycemia. She was suspected to have adrenal insufficiency and the cortisol blood level confirmed this diagnosis (0.19 mg/dl). Endocrinological examination revealed normal pituitary function except for very low serum concentrations of ACTH and cortisol. Ultrasound echocardiography showed normal cardiac size and function of the left ventricle. On the basis of this diagnosis, hydrocortisone replacement was started. After hydrocortisone replacement was started, the sodium level returned to normal and the QT intervals of ECG were normalized. Pituitary magnetic resonance imaging showed empty sella.
| Laboratory data | Normal range | |
| Na+ | 126 mEq/L | (136-146) |
| K+ | 5.7 mEq/L | (3.5-5.1) |
| Cortisol | 0.19 mg/dl | >18 |
| ACTH | 4 pg/ml | (4.7-40) |
Conclusion: Long QT syndrome is one of the symptoms of isolated ACTH deficiency and is known to be a risk factor for cardiovascular events. In these patients, prolonged QTs can be reversed by glucocorticoid replacement.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more