dipyridamole負荷心電図が陽性を示したACTH単独欠損症の1例

A Case of Isolated Adrenocorticotropin Deficiency Showing Positive on a Dipyridamole Stress Electrocardiogram

要旨　患者は57歳，女性．低血糖を契機にACTH単独欠損症と診断．虚血様心電図変化，dipyridamole負荷心電図陽性を示すも，心筋シンチ・冠動脈造影には異常なく，cortisol補充後の同負荷心電図は陰性化．副腎皮質機能低下症においてcortisol不足がdipyridamole負荷心電図偽陽性に関与することが示唆された．

　A 57-year-old woman was diagnosed as suffering from isolated adrenocorticotropin deficiency with frequent hypoglycemia as symptom. An electrocardiogram showed negative T-waves and prolonged QT intervals. The subsequent dipyridamole stress electrocardiogram was positive. However, neither dipyridamole stress myocardial scintigraphy nor the simultaneously performed coronary arteriography showed any significant ischemia or stenosis. After starting a cortisol supplement therapy, there was partial inprovement in negative T-waves and prolonged QT intervals, and the dipyridamole stress electrocardiogram became negative. In adrenocortical insufficiency, it was suggested that the shortage of cortisol contributed to the false positive of the dipyridamole stress electrocardiogram.