Abstract
Introduction: Panhypopituitarism can lead to major metabolic consequences as a result of multiple hormonal deficiencies. However, its association with life-threatening arrhythmias is not well known. Only a few cases have been reported in the literature. Case Report: A 38 year old woman with no past medical history presented with amenorrhea. She was found to have a high prolactin level and subsequent MRI showed a 2.7 cm pituitary adenoma. She underwent transsphenoidal resection and developed panhypopituitarism after surgery. She was placed on hydrocortisone, levothyroxine and desmopressin but was not been compliant with the medications. A few months later, she had a sudden onset syncopal episode without any prodromal symptom. On presentation, she had a heart rate of 43 bpm and prolonged QT/QTc of 668/564ms. Laboratory tests were significant for a troponin of 0.8ng/ml, n <0.03ng/ml, severe hypothyroidism (FT4 0.1ng/dl, n 0.8-2.2ng/dl; FT3 1.03pg/ml, n 2.77-5.27pg/ml) and adrenal insufficiency (AM cortisol <0.2mcg/dL, n 4.5-22.7mcg/dL). There were no other clinical findings to explain this. Her syncopal episode strongly suggested a VT/VF arrest. Echocardiogram showed no structural heart disease. She was treated appropriately for her hypothyroidism and adrenal insufficiency; and she wore a wearable defibrillator while the endocrine disorders were corrected. After treatment, her bradycardia resolved and her QT interval normalized. Genetic screening for underlying Long QT Syndromes was negative. Clinical Lesson: Panhypopituitarism, including hypothyroidism and adrenal insufficiency, can cause life threatening arrhythmias such as ventricular tachycardia and fibrillation. This can lead to extensive noninvasive and invasive cardiac testing and intervention. It is critical that clinicians be aware that these arrhythmias can be reversed by correcting the underlying endocrine disorders. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.