SHM Converge Scientific Abstract ePoster Gallery-Severe Qt Prolongation and Torsades De Pointes in Panhypopituitarism: A Reversible Endocrine Crisis

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A 27-year-old woman with a history of craniopharyngioma resection and panhypopituitarism presented with intractable vomiting despite following sick-day hydrocortisone instructions. In the emergency setting, she received ondansetron and then developed torsades de pointes (TdP), along with marked QT prolongation and sinus bradycardia. She was treated with IV magnesium, dopamine infusion, hormone replacement, and electrolyte repletion, after which her QTc normalized.<br /><br />Workup revealed severe central hypothyroidism, acute adrenal crisis, and significant hypokalemia. Prior labs also showed low FSH, LH, and IGF-1, supporting the diagnosis of panhypopituitarism as the underlying cause of the arrhythmia rather than primary cardiac disease.<br /><br />The case highlights that severe endocrine failure can present as a life-threatening cardiac rhythm disturbance. Panhypopituitarism is an underrecognized risk factor for QT prolongation and TdP, especially in patients with pituitary or neurologic disorders such as craniopharyngioma, pituitary apoplexy, autoimmune hypophysitis, or traumatic brain injury. The authors emphasize the importance of regular monitoring of electrolytes and QT interval in at-risk patients, and prompt treatment with steroids and thyroid hormone replacement to prevent potentially fatal arrhythmias.

Asset Subtitle

Amukta Nuney

Meta Tag

Author List Amir Ali Ahmadi, Amukta Nuney, Ankitha D. Rajesh, Dayita Wable, Hanna Cholerzynska, Hsiao-Man Chang, Hyunwoo Kim, Pardeep Guru, Riddhi Patel, Shahe Tchillingirian, Swarnima Das, Thomas F. Fusillo

Category Clinical Vignettes

Concept Panhypopituitarism

Concept Antipsychotic-Induced QT Prolongation

Concept Torsades de Pointes

Concept Steroid Replacement

Concept Levothyroxine Therapy

Distinguished Non-Finalist

Presenter Organization Mount Sinai Morningside/West

Presenting Author Amukta Nuney

Track Adult

Keywords

panhypopituitarism

torsades de pointes

QT prolongation

craniopharyngioma

adrenal crisis

central hypothyroidism

hypokalemia

sinus bradycardia

hydrocortisone

electrolyte repletion

Panhypopituitarism

Antipsychotic-Induced QT Prolongation

Torsades de Pointes

Steroid Replacement

Levothyroxine Therapy