cured without relapse. This cardiomyopathy is often triggered by the exposure to emotional, psychological, or physical stress, and is sometimes complicated by various endocrine disorders such as anorexia nervosa [2], pheochromocytoma [3], or adrenal insufficiency [4,5]. A small number of previous reports have referred to ampulla cardiomyopathy caused by adrenal insufficiency, which resolved promptly after steroid hormone replacement therapy without severe involvement. We herein report a patient with torsade de pointes worsening to ventricular fibrillation associated with recurrent ampulla cardiomyopathy, who was rescued by cardiopulmonary resuscitation including cardiac defibrillation and later proven to suffer from idiopathic ACTH deficiency. So far, this is the first report describing adrenal insufficiency induced torsade de pointes complicated by recurrent ampulla cardiomyopathy. Abstract. We describe here a patient with torsade de pointes associated with recurrent ampulla cardiomyopathy, who was later proven to suffer from idiopathic acTh deficiency. a 70-year-old man was admitted to our hospital for bacterial pneumonia. A cardiac examination performed on admission revealed ampulla cardiomyopathy, which improved spontaneously as the pneumonia was cured. Two months after discharge, he was transferred to our hospital for relapse of the pneumonia. After the second admission, the pneumonia subsided with antibiotic treatment and his general condition ameliorated gradually. However, on the 20 th hospital day, he was found lying on the floor in a prone position in cardiopulmonary arrest. cardiac telemetry monitoring showed torsade de pointes worsening to ventricular fibrillation, and immediate cardiac defibrillation was performed. The electrocardiogram after successful defibrillation showed inverted T waves in the chest leads with long QT intervals, and subsequent emergent coronary catherization revealed the recurrence of ampulla cardiomyopathy. Thereafter, endocrinological examinations for the diagnosis of sustained hyponatremia demonstrated secondary adrenal insufficiency caused by idiopathic acTh deficiency. The cardiomyopathy resolved promptly after steroid hormone replacement without relapse as did the hyponatremia. Patients with ampulla cardiomyopathy or ventricular fibrillation without apparent etiology should be examined for adrenal function. If begun as soon as adrenal insufficiency is diagnosed, immediate steroid replacement therapy can prevent the deterioration and relapse of cardiac involvement.

A 34-year-old man with a history of rectal cancer was receiving oral chemotherapy [tegafur-uracil (UFT) with leucovorin]. He visited our hospital due to nausea and abdominal pain, and his laboratory data revealed the presence of urinary ketones, hyperglycemia and high anion gap metabolic acidosis, and HbA1c level of 6.8%. Accordingly, we diagnosed fulminant type 1 diabetes. The development of fulminant type 1 diabetes during chemotherapy for malignancy is a rare, but potentially fatal condition. Therefore, clinicians should consider diabetic ketoacidosis in the differential diagnosis when examining chemotherapy patients who present with gastrointestinal symptoms.

We report the case of a 38-year-old

Insulinoma is the most common cause of fasting hypoglycemia resulting from autonomous insulin hyper