興味ある心電図異常を呈した下垂体機能不全症の2例

Two Cases of Hypopituitarism with Electrocardiographic Abnormalities

　症例1は84歳，男性．以前失神発作あり，心電図上QT延長，non-sustained VTを認め，原因として副腎皮質機能低下症が疑われプレドニゾロン（PDZ）補充にて改善した．PDZ中止にて再び前回同様の心電図異常を認め，再入院となった．各種負荷試験にてACTH単独欠損症と考えられコルチゾール補充療法にて心電図異常も改善した．

　症例2は59歳，男性．意識障害にて入院．恥毛，腋毛の脱落，低Na血症を認めた．各種負荷試験にて汎下垂体機能低下症と考えられ，頭部MRIにてempty sellaの所見であった．入院時心電図所見にてQT延長，洞性徐脈，陰性T波を認めたが，ハイドロコーチゾン，甲状腺ホルモン補充療法にて改善した．下垂体機能低下症と心電図異常とを関連づけた報告は少ないが，心電図異常の原因として内分泌疾患も念頭におく必要があると思われた．

The first case was a man of 84 years of age, with a past history of fainting associated with a prolonged QT interval and non-sustained VT on the electrocardio-gram (ECG). He was suspected of suffering from adrenocotical hypofunction. His symptom improved after treatment with prednisolone. During his clinical follow-up, he suffererd from a similar crisis after with-drawal of prednisolone and was again hospitelized. After various loading tests, isolated adrenocorticotropin deficiency was revealed. Therapy with cortisol im-proved his electrocardiographic abnormalities. The sec-ond case was a 59-year-old man who was admitted for disturbance of consciousness, and loss of pubic and axillary hair. Panhypopituitarism was diagnosed based on the results of various loading tests, the MRI findings being compatible with the diagnosis of empty sella. On admission. the ECG showed a prolonged QT interval, sinusal bradycardia and negative T wave. Theseelectrocardiographic abnormalities improved after administration of hydrocortisol and thyroid hormones. Reports on the association between hypopituitarism and electrocardiographic abnormalities are uncommon. Endocrinological diseases must also be taken into con-sideration as a potential causative factor of electrocar-diographic abnormalities.