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Zhang J, Zou Y, Chen X, Pan J, Yu H, Wang Y, Wu Y, Zou H. Extremely dangerous hypopituitarism related long QT syndrome and transient ST-segment elevation: A case report. SAGE Open Med Case Rep 2023; 11:2050313X221147194. [PMID: 36636098 PMCID: PMC9829875 DOI: 10.1177/2050313x221147194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023] Open
Abstract
Acquired long QT syndrome caused by hypopituitarism and transient ST-segment elevation has not been reported in cardiac arrest patients. We report a case of extremely dangerous acquired long QT syndrome and transient ST-segment elevation. A 44-year-old Chinese woman with renal failure experienced sudden cardiac arrest in the haemodialysis room. Subsequent electrocardiogram showed QT prolongation and transient ST-segment elevation. This patient's medical history, subsequent laboratory results and pituitary magnetic resonance imaging suggested hypopituitarism. Transient ST-segment elevation on the electrocardiogram was considered to be caused by repeated direct current shocks. The patient was diagnosed with acquired long QT syndrome and was not taking any antiarrhythmic drugs. Her corrected QT interval normalized after hormone replacement therapy. This case highlights the importance of the awareness of hypopituitarism; early identification and intervention can prevent the occurrence of this life-threatening arrhythmia. ST-segment elevation is not always due to acute myocardial infarction, and a variety of other causes, especially electrical cardioversion, should be considered.
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Affiliation(s)
- Jia Zhang
- Department of Inspection Medical, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - Yingying Zou
- Digestive System Department, The Third Affiliated Hospital of Qiqihar Medical College, Qiqihar, China
| | - Xiaoshu Chen
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - Jingye Pan
- Department of General and Intensive Care Medical, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haizhu Yu
- Department of General Practice, Zhejiang Hospital, Hangzhou, China
| | - Yi Wang
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - Yanran Wu
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - He Zou
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China,He Zou, Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou 325035, Zhejiang, China.
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Shinde SD, Sabnis GR, Lanjewar CP, Kerkar PG. A rare endocrine cause of electrical storm - a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2017; 1:ytx008. [PMID: 31020067 PMCID: PMC6176984 DOI: 10.1093/ehjcr/ytx008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/18/2017] [Accepted: 10/04/2017] [Indexed: 11/30/2022]
Abstract
Sheehan’s syndrome, also called Simmond’s syndrome, postpartum apoplexy, postpartum pituitary necrosis, and postpartum panhypopituitary syndrome, is the name given to postpartum hypopituitarism. The syndrome is caused by an infarction in the adenohypophysis, usually precipitated by massive uterine haemorrhage and hypovolemic shock during or after childbirth. Extensive destruction of pituitary cells results in varying degree of hypopituitarism. Acute loss of adenohypophysis function can be fatal without glucocorticoid and thyroid replacement therapy and survivors will require life time hormonal replacement therapy. Most cases present in the postpartum period with lactation failure or after months to years after the delivery. In many affected women, anterior pituitary dysfunction is not diagnosed for many years. Dyselectrolytemia is one of a common presentation in Sheehan’s syndrome. Herein, we report a case of a 35-year old female with a history of obstetric hysterectomy 2 years ago in view of severe postpartum haemorrhage with history of failure of lactation and three episodes of syncope since last 1½ years and now presented with polymorphic ventricular tachycardia which required DC cardioversion. She was referred as a case of long QT syndrome. On investigating further, she had hypokalaemia secondary to hypopituitarism due to Sheehan’s syndrome.
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Affiliation(s)
- Sunny D Shinde
- Department of Cardiology, Seth G S Medical College and King Edward VII Memorial Medical College, Acharya Donde Marg, Parel, Mumbai 400012, India
| | - Girish R Sabnis
- Department of Cardiology, Seth G S Medical College and King Edward VII Memorial Medical College, Acharya Donde Marg, Parel, Mumbai 400012, India
| | - Charan P Lanjewar
- Department of Cardiology, Seth G S Medical College and King Edward VII Memorial Medical College, Acharya Donde Marg, Parel, Mumbai 400012, India
| | - Prafulla G Kerkar
- Department of Cardiology, Seth G S Medical College and King Edward VII Memorial Medical College, Acharya Donde Marg, Parel, Mumbai 400012, India
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Hajsheikholeslami F, Yazdani S. Sudden cardiac death as a result of neglected hypopituitarism. Int J Endocrinol Metab 2013; 11:117-9. [PMID: 23825983 PMCID: PMC3693667 DOI: 10.5812/ijem.5374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 08/12/2012] [Accepted: 08/17/2012] [Indexed: 11/16/2022] Open
Abstract
Cardiac involvement infrequently occurs in hypopituitarism, and lethal cardiac arrhythmias are rarely reported. We present a middle age female who died as a consequence of refractory ventricular arrhythmia whose medical history and previous laboratory investigation were consistent with hypopituitarism. We conclude that hypopituitarism may lead to electrocardiographic changes and malignant ventricular arrhythmia and should be included in laboratory investigation and differential diagnosis of patients presenting with long QT syndrome.
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Affiliation(s)
- Farhad Hajsheikholeslami
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences Tehran, IR Iran
- Corresponding author: Farhad Hajsheikholeslami, Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences Tehran, IR Iran. Tel: +98-212243250 Fax: +98-2122416264, E-mail:
| | - Shahrooz Yazdani
- Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences Tehran, IR Iran
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A Case of QT Prolongation Associated with Panhypopituitarism. Case Rep Endocrinol 2013; 2013:989745. [PMID: 23762665 PMCID: PMC3665245 DOI: 10.1155/2013/989745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 04/17/2013] [Indexed: 11/17/2022] Open
Abstract
We describe a 37-year-old patient with panhypopituitarism who experienced symptoms and signs of hormonal insufficiency and QT prolongation on electrocardiogram without electrolyte disturbances. After hormonal (steroidal and thyroid) replacement therapy electrocardiographic findings were normalized. Hormonal disorders should be considered as a cause of long QT intervals which may lead to torsade de pointes, even if plasma electrolyte levels are normal, because life-threatening arrhythmia is treatable by supplementation of the hormone that is lacking.
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Izumi C, Inoko M, Kitaguchi S, Himura Y, Iga K, Gen H, Konishi T. Polymorphic ventricular tachycardia in a patient with adrenal insufficiency and hypothyroidism. JAPANESE CIRCULATION JOURNAL 1998; 62:543-5. [PMID: 9707014 DOI: 10.1253/jcj.62.543] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe a 60-year-old patient with adrenal insufficiency and hypothyroidism who experienced syncope as a result of polymorphic ventricular tachycardia associated with long QT intervals. The deep inverted T waves and long QT intervals were normalized about 8 weeks after starting steroid replacement therapy. Although there have been some reports on electrocardiographic abnormality or polymorphic ventricular tachycardia in patients with adrenal insufficiency, the pathogenesis remains unknown. Hormonal disorders should be considered as a cause of polymorphic ventricular tachycardia associated with long QT intervals, even if plasma electrolyte levels are normal, because life-threatening arrhythmia is treatable by supplementation of the hormone that is lacking.
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Affiliation(s)
- C Izumi
- Department of Cardiology, Tenri Hospital, Tenri-city, Nara, Japan
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