ECE2014 Poster Presentations Pituitary Clinical (<emphasis role="italic">Generously supported by IPSEN</emphasis>) (108 abstracts)
A case of an isolated ACTH deficiency who had a prolonged QT interval
Hiroshi Asano 1 , Rikako Suzuki 1 , Takeshi Hayashi 1 , Masaya Sakamoto 1 , Hideki Katakami 2 , Katsuyoshi Tojo 1 & Kazunori Utsunomiya 1
1Division of Diabetes, Metabolism and Endocrinology, the Jikei University School of Medicine, Tokyo, Japan; 2Department of Internal Medicine, Teikyo University, Chiba Medical Center, Chiba, Japan.
A 77-year-old female had a loss of appetite, severe fatigue and hyponatremia (127–135 mmol/l) for 2 months. She was diagnosed as depression, and was psychiatrically hospitalized. After admission, she was beginning to take antidepressants, but they did not work at all. To examine hyponatremia, endocrinological examination was done, then low plasma ACTH (2.0 pg/ml) and cortisol (1.3 μg/dl) was found. Brain MRI examination showed no remarkable findings in pituitary. We did a loading test for anterior pituitary function (ACTH/cortisol didn’t raise after CRH test to 120 min; ACTH was 2.0 pg/ml and cortisol was 1.0 μg/dl), and diagnosed an isolated ACTH deficiency (IAD). After we started steroid replacement therapy, her fatigue and loss of appetite was disappeared dramatically. Hyponatremia was also improved.
We experienced a case of IAD, which was frequently misdiagnosed as a psychiatric disease. Before steroid replacement therapy, her electrocardiogram (ECG) showed a prolonged QT interval (QTc 0.474 Sec), and after replacement, it was improving (QTc 0.450 Sec).
In Japan, some adrenal insufficiency patients who had a prolonged QT interval experienced fatal arrhythmias, and after steroid replacement therapy, in all cases QT intervals were improved. Under hospitalization, she once had a loss of consciousness before replacement. It is unclear that whether she had an arrhythmia or not because we could not check ECG at that time.
It is said that prolonged QT intervals with adrenal insufficiency are caused by electrolyte abnormalities, reversible myocardial changes due to hypoglycemia and hyponatremia, and, potassium channelopathies on myocardiocytes and so on. It is important to check ECG with adrenal insufficy to avoid fatal arrhythmias.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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