ABSTRACT
Background : Abiraterone has applications in the treatment of prostate cancer. It can potentially be associated with various cardiac arrhythmias, such as torsade de pointes. We report a case where the patient experienced syncope episodes following the administration of this medication, and torsade de pointes was detected during monitoring.
Case summary: A 73-year-old man with a history of hypertension and prostate cancer presented to the emergency department with complaints of syncope. He was taking medications for his conditions, including abiraterone acetate and bicalutamide. An ECG revealed a prolonged QT interval and continuous cardiac monitoring showed multiple premature ventricular contractions (PVCs) followed by torsade de pointes. The patient was admitted to the cardiac care unit, hypomagnesemia was corrected and abiraterone was discontinued.
Discussion: Abiraterone is a medication used to treat metastatic castration-resistant prostate cancer by inhibiting the enzyme CYP17A1, reducing androgen levels. However, it has been associated with cardiovascular toxicity, including an increased risk of cardiovascular events. Abiraterone can also prolong the QT interval, potentially leading to life-threatening arrhythmias. Additionally, it can cause hypokalemia and fluid retention due to redirection of corticosteroid precursors. The mechanism of hypogonadism in long QT syndrome is not fully understood, but there is evidence suggesting a link between testosterone deficiency and genetic abnormalities causing LQTS. Further research is needed to understand these relationships and identify appropriate treatment strategies. Regular monitoring for electrolyte disturbances and EKG status is recommended for patients taking abiraterone.