Key result
Administration of intravenous steroids in a patient with adrenal insufficiency improved her prolonged QTc from 577 ms to 462 ms and resolved episodes of Torsade de Pointes.
Why the study?
QT interval prolongation in adrenal insufficiency is well-known but rarely prolonged enough to cause Torsade de Pointes.
Does steroid administration improve prolonged QTc and prevent Torsade de Pointes in patients with adrenal insufficiency?
Case Report (n=1)
No
Does steroid administration improve prolonged QTc and prevent Torsade de Pointes in patients with adrenal insufficiency?
Adrenal insufficiency is a potentially reversible cause of prolonged QT and Torsade de Pointes that can be successfully treated with steroid administration.
Answers are grounded in this paper and cite their sources.
May support steroids for QT prolongation in adrenal insufficiency; hypothesis-generating pending prospective trials.
Introduction: Long QT syndrome (LQTS) is the congenital or acquired prolongation of the QT interval on an electrocardiogram (ECG). It is well-known that the QT interval is prolonged in adrenal insufficiency (AI) but rarely prolonged enough to cause Torsade de Pointes (TdP). Case Report: Here we report a case of TdP and cardiac arrest in a patient with adrenal insufficiency. The patient had a return of spontaneous circulation after a successful cardiopulmonary resuscitation (CPR). Electrocardiograms persistently showed prolonged QT corrected for heart rate (QTc) prior to and at the time of cardiac arrest, some exceeding 600 milliseconds (ms). The QT interval improved significantly upon administration of steroids and the episodes of TdP resolved. Conclusion: This case highlights the importance of recognizing adrenal insufficiency (AI) as a potentially reversible cause of prolonged QT and TdP.
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Ahmed et al. (2022) conducted a case report in Adrenal insufficiency with prolonged QTc and Torsade de Pointes (n=1). Intravenous steroids (hydrocortisone) was evaluated on QTc interval. Administration of intravenous steroids in a patient with adrenal insufficiency improved her prolonged QTc from 577 ms to 462 ms and resolved episodes of Torsade de Pointes.
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