Torsade de Pointes como primera manifestación de insuficiencia suprarrenal

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.