Torsade de Pointes como primera manifestación de insuficiencia suprarrenal

Virgilio Martínez-Mateo , Julia Silva-Fernández , Manuel José Fernández-Anguita , Laura Cejudo-del Campo
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Abstract

We describe a case of Torsade de Pointes as first manifestation of adrenal insufficiency. A 56-year-old female without remarkable medical history was admitted in our hospital because syncopes in last 24 hours. Repetitive polymorphic ventricular tachycardia were documented in the setting of QT interval prolongation. Indeed, spontaneous hypothermia, severe hypoglycemia and hyponatremia (125 mEq/ml) were appearing progressively. Due to high clinical suspicion of adrenal insufficiency and patient status of vital emergency an empirical treatment with high doses of glucocorticoids was started. Under this treatment, metabolic and electrocardiographic abnormalities were progressive corrected. The complete endocrine study detected systemic low level of cortisol with normal values of ACTH suggesting diagnosis of secondary adrenal insufficiency due to an empty sellar documented in a craneal magnetic resonance. Our case illustrates that adrenal insufficiency should be considered in patients with QT prolongation and Torsade de Pointes since an urgent correction of cortisol levels is crucial to improve the prognosis of these patients.

尖扭转是肾上腺功能不全的第一表现
我们描述了一个病例扭转角作为肾上腺功能不全的第一表现。女,56岁,无明显病史,近24小时因晕厥入住我院。重复多态室性心动过速在QT间期延长的情况下被记录下来。事实上,自发性低体温、严重低血糖和低钠血症(125 mEq/ml)逐渐出现。由于临床高度怀疑肾上腺功能不全和患者危重状态,开始了高剂量糖皮质激素的经验性治疗。在这种治疗下,代谢和心电图异常逐渐得到纠正。完整的内分泌研究发现全身低水平的皮质醇与正常的ACTH值提示继发性肾上腺功能不全的诊断,由于空的销售记录在颅磁共振。我们的病例表明,肾上腺功能不全应考虑到QT延长和扭转角患者,因为紧急纠正皮质醇水平对改善这些患者的预后至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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