Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma

Giavarini, Alessandra; Chédid, Antoine; Bobrie, Guillaume; Plouin, Pierre‐François; Hagège, Albert; Amar, Laurence

doi:10.1136/heartjnl-2013-304073

Cited by 115 publications

(108 citation statements)

References 23 publications

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“…Cardiovascular complications, such as hypertensive crisis and catecholamine-induced cardiomyopathy, are known to be the most frequent causes of life-threatening events in pheochromocytoma patients as summarized in a recently published review of the literature (12). Additionally, Giavarini et al (10) reported that 11% of pheochromocytoma patients present with acute catecholamineinduced cardiomyopathy. In agreement with these studies, four of our patients suffered from pheochromocytoma-induced Tako-Tsubo cardiomyopathy and presented with the sequence of hypertensive crisis followed by hypotensive shock.…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

“…In 2013, Scholten et al (11) published a retrospective comprehensive study analyzing the perioperative management of pheochromocytoma crisis and recommended an elective adrenalectomy after cardiovascular stabilization and a-blockade; 137 patients from one United States center were included and zero mortality was reported. In the same year, Giavarini et al (10) presented a retrospective study including 140 patients with pheochromocytoma from a French center. They found catecholamine-induced cardiomyopathy in 11% of the patients and recommend screening for pheochromocytoma in patients with acute heart failure without evidence of valvular or coronary heart disease.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, lack of any mortality is usually reported in the vast majority of series, and most life-threatening complications appear as anecdotal case reports in the literature. To our knowledge only two systematic studies have addressed this issue, thereby providing the basis of a better judgment of this situation (10,11). In 2013, Scholten et al (11) published a retrospective comprehensive study analyzing the perioperative management of pheochromocytoma crisis and recommended an elective adrenalectomy after cardiovascular stabilization and a-blockade; 137 patients from one United States center were included and zero mortality was reported.…”

Section: Introductionmentioning

confidence: 99%

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Life-threatening events in patients with pheochromocytoma

Riester

Weismann

Quinkler

et al. 2015

European Journal of Endocrinology

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Objective: Pheochromocytomas are rare chromaffin cell-derived tumors causing paroxysmal episodes of headache, palpitation, sweating and hypertension. Life-threatening complications have been described in case reports and small series. Systematic analyses are not available. We took an opportunity of a large series to make a survey. Design and methods: We analyzed records of patients diagnosed with pheochromocytomas in three geographically spread German referral centers between 2003 and 2012 (nZ135). Results: Eleven percent of the patients (ten women, five men) required in-hospital treatment on intensive care units (ICUs) due to complications caused by unsuspected pheochromocytomas. The main reasons for ICU admission were acute catecholamine induced Tako-Tsubo cardiomyopathy (nZ4), myocardial infarction (nZ2), acute pulmonary edema (nZ2), cerebrovascular stroke (nZ2), ischemic ileus (nZ1), acute renal failure (nZ2), and multi organ failure (nZ1). One patient required extracorporeal membrane oxygenation due to a hypertensive crisis with lung edema occurring during delivery (nZ1). Two patients died of refractory shock and pheochromocytomas were found postmortem. Two patients were treated by emergency surgery. Compared to pheochromocytoma patients without life-threatening events (nZ120), patients with complications had a significant larger maximal tumor diameter (7.0 vs 4.5 cm, P!0.01), higher levels of catecholamines (20-vs ninefold upper limit of normal, P!0.01), and tended to be younger (42 vs 51 years, PZ0.05). Conclusion: Although pheochromocytomas are rare, they are likely to be associated with a life-threatening situation. Clinicians have to be aware of these situations and perform a timely diagnosis.

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Section: European Journal Of Endocrinologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Life-threatening events in patients with pheochromocytoma

Riester

Weismann

Quinkler

et al. 2015

European Journal of Endocrinology

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“…Pulmonary edema is a rare clinical manifestation of pheochromocytoma, especially in patients with normal blood pressure or hypotension (Eschen et al, 2007;Giavarini et al, 2013). In most pheochromocytoma cases, pulmonary edema is cardiogenic and is caused by myocardial infarction, cardiomyopathy, and severe arrhythmias.…”

Section: Correspondencementioning

confidence: 99%

Recurrence of non-cardiogenic pulmonary edema and sustained hypotension shock in cystic pheochromocytoma

Jin

Chen

Yang

et al. 2017

J. Zhejiang Univ. Sci. B

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Pheochromocytoma is a rare neuroendocrine tumor which derives from chromaffin cells of the adrenal gland or relevant to sympathetic nerves and ganglia. The clinical features of pheochromocytoma are various. Paroxysmal episodes of serious hypertension, headache, palpitation, and diaphoresis are the typical manifestations (Bravo, 2004). Hypotension shock, pulmonary edema, and acute coronary syndrome induced by pheochromocytoma are uncommon (Malindretos et al., 2008;Batisse-Lignier et al., 2015). In this study, we present a rare case of cystic pheochromocytoma causing recurrent hypotension shock, non-cardiogenic pulmonary edema, and acute coronary syndrome, and the possible mechanisms are discussed.A 54-year-old woman presented to the emergency department with recurrent chest pain and dyspnea for 2 years, which have been aggravated for 4 h. She had no complaints of headache, cough, or palpitation. She had a history of pollen allergy but no other disease. On physical examination, the patient was afebrile. Her heart rate was 95 beats/min, blood pressure was 105/78 mmHg, respiratory rate was 21 breaths per minute, and oxygen saturation was 93% in ambient air. Much moist rale was audible, and examination of heart and abdomen had no abnormal findings. Emergency troponin I increased (2.34 µg/L; normal range 0-0.04 µg/L). An initial electrocardiogram (ECG) showed V4-V6 ST depression. Coronary angiography and computed tomography (CT) pulmonary angiogram were normal. Contrast-enhanced CT of the chest showed diffuse lesions in the lungs, large numbers of alveoli with inflammatory exudation (Fig. S1). IgE was positive, and influenza A and B virus antigens were negative. Brain natriuretic peptide was normal (62.7 pg/ml; normal range 0-100 pg/ml). The transthoracic echocardiogram was normal and left ventricular ejection fraction was 71.7%. She developed shock with hypotension (68/34 mmHg), and was stabilized with dopamine and norepinephrine for about 30 h. The initial diagnosis was hypersensitivity pneumonitis. After treatment with methylprednisolone and antibiotics, the patient got well and was discharged. One week later, serious chest pain and dyspnea attacked again, and abdomen B ultrasound showed weak echo mass (about 4 cm×3.5 cm×3.5 cm) in the retroperitoneum. Contrast-enhanced magnetic resonance imaging showed a cystic lesion of the left adrenal gland, which was considered as pheochromocytoma (Fig. 1). The patient recovered after surgery, and histological analysis (Fig. 2) confirmed the diagnosis of pheochromocytoma. At 1 year of follow-up, there was no recurrence of chest pain.Pheochromocytoma has an estimated incidence of 0.005%-0.100% in the worldwide population and 0.1%-0.6% in the hypertension population (Omura et al.,

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“…The incidence of TTS is reported to be only approximately 5% in clinical pheochromocytoma patients. 5 (d) The mortality associated with experimental TTS induced with high-dose catecholamine administration in small animals Is High-Dose Catecholamine Administration in Small Animals an Appropriate Model for Takotsubo Syndrome?…”

mentioning

confidence: 99%

Is High-Dose Catecholamine Administration in Small Animals an Appropriate Model for Takotsubo Syndrome?

Angelini¹,

Tobis

2015

Circ J

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Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma

Abstract: PPGL may present as ACC in 11% of cases, excluding patients dying from undiagnosed tumours. Left ventricular dysfunction is usually reversible before surgery. PPGL should be suspected in patients with acute heart failure without evidence of valvular or coronary artery disease.

Cited by 115 publications

References 23 publications

Life-threatening events in patients with pheochromocytoma

Life-threatening events in patients with pheochromocytoma

Recurrence of non-cardiogenic pulmonary edema and sustained hypotension shock in cystic pheochromocytoma

Is High-Dose Catecholamine Administration in Small Animals an Appropriate Model for Takotsubo Syndrome?

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