Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Acquired Long QT Syndrome Manifesting with Torsades de Pointes in a Patient with Panhypopituitarism due to Radiotherapy

  • Kang, Dae Gil (Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Kim, Sung Eun (Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Park, Myoung Soo (Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Kim, Eun Jung (Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Lee, Jun Hee (Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Park, Dae Gyun (Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Han, Kyoo Rok (Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Oh, Dong Jin (Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center)
  • Published : 2013.05.30
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Abstract

We describe a 64-year-old male patient with panhypopituitarism who experienced polymorphic ventricular tachycardia (VT) associated with long QT intervals. The panhypopituitarism developed as a sequelae of radiation therapy administered 20 years prior to his current presentation and was recently aggravated by urinary tract infection with sepsis. In this case, polymorphic VT was resistant to conventional therapy (including magnesium infusion), and QT prolongation and T wave inversion were normalized after the administration of steroid and thyroid hormones. Thyroid hormone is generally known to be associated with torsades de pointes (TdP), but steroid or other hormones may also provoke TdP. Hormonal disorders should be considered as a cause of polymorphic VT with long QT intervals. Some arrhythmias can be life-threatening, and they can be prevented with supplementation of the insufficient hormone.

Keywords

References

  1. Roden DM. A practical approach to torsade de pointes. Clin Cardiol 1997;20:285-90. https://doi.org/10.1002/clc.4960200318
  2. Molokhia M, Pathak A, Lapeyre-Mestre M, et al. Case ascertainment and estimated incidence of drug-induced long-QT syndrome: study in Southwest France. Br J Clin Pharmacol 2008;66:386-95. https://doi.org/10.1111/j.1365-2125.2008.03229.x
  3. Sanaei-Zadeh H, Shahmohammadi F, Zamani N, Mostafazadeh B. Can death unrelated to secondary causes be predicted in intubated comatose tricyclic antidepressant-poisoned patients? Clin Toxicol (Phila) 2011;49:379-84. https://doi.org/10.3109/15563650.2011.587125
  4. Hume-Smith HV, Sanatani S, Lim J, Chau A, Whyte SD. The effect of propofol concentration on dispersion of myocardial repolarization in children. Anesth Analg 2008;107:806-10. https://doi.org/10.1213/ane.0b013e3181815ce3
  5. Shojaie M, Eshraghian A. Primary hypothyroidism presenting with Torsades de pointes type tachycardia: a case report. Cases J 2008;1:298. https://doi.org/10.1186/1757-1626-1-298
  6. Schenck JB, Rizvi AA, Lin T. Severe primary hypothyroidism manifesting with torsades de pointes. Am J Med Sci 2006;331:154-6. https://doi.org/10.1097/00000441-200603000-00008
  7. Nishizawa S, Nakamura T, Hamaoka T, Matsumuro A, Sawada T, Matsubara H. Lethal arrhythmia and corticosteroid insufficiency. Am J Emerg Med 2009;27:1167.e1-3.
  8. Kim NH, Cho JG, Ahn YK, et al. A case of torsade de pointes associated with hypopituitarism due to hemorrhagic fever with renal syndrome. J Korean Med Sci 2001;16:355-9. https://doi.org/10.3346/jkms.2001.16.3.355
  9. Izumi C, Inoko M, Kitaguchi S, et al. Polymorphic ventricular tachycardia in a patient with adrenal insufficiency and hypothyroidism. Jpn Circ J 1998;62:543-5. https://doi.org/10.1253/jcj.62.543
  10. Hartog M, Joplin GF. Effects of cortisol deficiency on the electrocardiogram. Br Med J 1968;2:275-7. https://doi.org/10.1136/bmj.2.5600.275
  11. Takimoto K, Levitan ES. Glucocorticoid induction of Kv1.5 K+ channel gene expression in ventricle of rat heart. Circ Res 1994;75:1006-13. https://doi.org/10.1161/01.RES.75.6.1006
  12. Iga K, Hori K, Gen H. Deep negative T waves associated with reversible left ventricular dysfunction in acute adrenal crisis. Heart Vessels 1992;7:107-11. https://doi.org/10.1007/BF01744458
  13. Sauer AJ, Moss AJ, McNitt S, et al. Long QT syndrome in adults. J Am Coll Cardiol 2007;49:329-37. https://doi.org/10.1016/j.jacc.2006.08.057
  14. Odening KE, Choi BR, Koren G. Sex hormones and cardiac arrest in long QT syndrome: does progesterone represent a potential new antiarrhythmic therapy? Heart Rhythm 2012;9:1150-2. https://doi.org/10.1016/j.hrthm.2012.02.028

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