PDF(Pubmed)
Abstract：
BACKGROUND: Abiraterone, an androgen deprivation therapy, has been used in the treatment of metastatic castration-resistant prostate cancer (mCRPC). It has been associated with increased risks of hypokalaemia and cardiac disorders. We report a case of torsades de pointes (TdP) associated with abiraterone use and refractory hypokalaemia in a man with mCRPC.
METHODS: A 78-year-old man with mCRPC presented to the emergency room for generalized weakness. Laboratory results revealed a potassium level of 2.2 mmol/L (3.5-5.0), magnesium level of 2.4 mg/dL (1.6-2.5), and normal kidney and hepatic functions. Initial electrocardiogram showed atrial fibrillation with rapid ventricular rate of 106 b.p.m., frequent premature ventricular contractions, and a QTc of 634 ms. The patient had multiple episodes of TdP, became pulseless and underwent advanced cardiac life support, including defibrillation. Despite a total of 220 mEq of intravenous potassium chloride, his potassium level only improved to 2.8 mmol/L. He received spironolactone and amiloride to promote urinary potassium reabsorption in addition to hydrocortisone, in an effort to reduce abiraterone\'s effect on increasing mineralocorticoid synthesis.
CONCLUSIONS: Abiraterone has been widely used in mCRPC since its approval by the Food and Drug Adminstration in 2011. Regulatory guidelines and standardized close QTc and electrolyte monitoring in patients may help prevent fatal arrhythmias associated with abiraterone.
METHODS: A 78-year-old man with mCRPC presented to the emergency room for generalized weakness. Laboratory results revealed a potassium level of 2.2 mmol/L (3.5-5.0), magnesium level of 2.4 mg/dL (1.6-2.5), and normal kidney and hepatic functions. Initial electrocardiogram showed atrial fibrillation with rapid ventricular rate of 106 b.p.m., frequent premature ventricular contractions, and a QTc of 634 ms. The patient had multiple episodes of TdP, became pulseless and underwent advanced cardiac life support, including defibrillation. Despite a total of 220 mEq of intravenous potassium chloride, his potassium level only improved to 2.8 mmol/L. He received spironolactone and amiloride to promote urinary potassium reabsorption in addition to hydrocortisone, in an effort to reduce abiraterone\'s effect on increasing mineralocorticoid synthesis.
CONCLUSIONS: Abiraterone has been widely used in mCRPC since its approval by the Food and Drug Adminstration in 2011. Regulatory guidelines and standardized close QTc and electrolyte monitoring in patients may help prevent fatal arrhythmias associated with abiraterone.
摘要：
背景：阿比特龙，雄激素剥夺疗法,已用于治疗转移性去势抵抗性前列腺癌（mCRPC）。它与低钾血症和心脏疾病的风险增加有关。我们报告了一例与mCRPC患者使用阿比特龙和难治性低钾血症相关的尖端扭转（TdP）病例。
方法：一名患有mCRPC的78岁男子因全身无力而被送往急诊室。实验室结果显示钾水平为2.2mmol/L（3.5-5.0），镁水平为2.4mg/dL（1.6-2.5），和正常的肾脏和肝功能。最初的心电图显示房颤，快速心室率为106b.p.m.，频繁的室性早搏，和634毫秒的QTc。病人有多次TdP发作,变得无脉，接受了先进的心脏生命支持，包括除颤。尽管静脉注射氯化钾总共有220mEq，他的钾水平仅提高到2.8mmol/L。除氢化可的松外，他还接受了螺内酯和阿米洛利以促进尿钾的重吸收，努力减少阿比特龙对增加盐皮质激素合成的影响。
结论：阿比特龙自2011年获得食品和药物管理局批准以来，已广泛用于mCRPC。患者的监管指南和标准化的紧密QTc和电解质监测可能有助于预防与阿比特龙相关的致命心律失常。
方法：一名患有mCRPC的78岁男子因全身无力而被送往急诊室。实验室结果显示钾水平为2.2mmol/L（3.5-5.0），镁水平为2.4mg/dL（1.6-2.5），和正常的肾脏和肝功能。最初的心电图显示房颤，快速心室率为106b.p.m.，频繁的室性早搏，和634毫秒的QTc。病人有多次TdP发作,变得无脉，接受了先进的心脏生命支持，包括除颤。尽管静脉注射氯化钾总共有220mEq，他的钾水平仅提高到2.8mmol/L。除氢化可的松外，他还接受了螺内酯和阿米洛利以促进尿钾的重吸收，努力减少阿比特龙对增加盐皮质激素合成的影响。
结论：阿比特龙自2011年获得食品和药物管理局批准以来，已广泛用于mCRPC。患者的监管指南和标准化的紧密QTc和电解质监测可能有助于预防与阿比特龙相关的致命心律失常。
