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.