Abstract
Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare disorder, characterized by secondary adrenal insufficiency. We experienced a case of isolated ACTH deficiency presented with prolonged QT intervals which was helpful in diagnosis. Hereby we report our case and review the previous cases. We describe a 77 year-old female whose major complaints were general malaise, anorexia, and depression. On admission, QT intervals of ECG were prolonged. Endocrine tests indicated that she was suffering from isolated ACTH deficiency. After hydrocortisone replacement therapy was started, QT intervals were shortened and all of her complaints were resolved. There are only six reports about isolated ACTH deficiency associated with prolonged QT intervals until now. Prolongation of QT intervals is known to be a risk factor for cardiovascular events such as ventricular fibrillation, but interestingly prolonged QT intervals associated with isolated ACTH deficiency infrequently cause lethal arrhythmia. The initial symptoms of adrenal deficiency in elderly patients are obscure and adrenal deficiency is often misdiagnosed as unidentified clinical syndrome. It is important to consider isolated ACTH deficiency when recognizing unexplained prolonged QT intervals.
Highlights
Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder, characterized by secondary adrenal insufficiency with low or absent cortisol production, normal secretion of pituitary hormones except ACTH and the absence of structural pituitary defects [1]
Since the reports in the 1950s, ECG abnormalities such as flat or inverted T waves, prolonged QT intervals are known to occur in adrenal insufficiency [2,3,4]
We report a case of IAD whose ECG abnormalities were reversed with hydrocortisone replacement, suggesting a role played by glucocorticoids in the modulation of QT intervals
Summary
Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder, characterized by secondary adrenal insufficiency with low or absent cortisol production, normal secretion of pituitary hormones except ACTH and the absence of structural pituitary defects [1]. We report a case of IAD whose ECG abnormalities were reversed with hydrocortisone replacement, suggesting a role played by glucocorticoids in the modulation of QT intervals. A 77 year-old female patient was admitted to our hospital with major complaints of general malaise, appetite loss, depression and weight loss (7 kg over one month) First she visited the psychiatrist, and hyponatremia (130 mmol/l) was detected by blood test. ECG demonstrated negative flat T waves and prolonged QTc intervals (0.474 sec) in all leads (Figure 1). Magnetic resonance imaging revealed no organic lesions or atrophy of pituitary gland These data indicated that she was suffering from isolated ACTH deficiency.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
