Adrenal pheochromocytoma presenting with Takotsubo-pattern cardiomyopathy and acute heart failure

Chiang, Yi-Lun; Chen, Pei-Chi; Lee, Chin-Cheng; Chua, Su‐Kiat

doi:10.1097/md.0000000000004846

Cited by 21 publications

(17 citation statements)

References 12 publications

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“…Because of the extreme similarities between two reported pheochromocytoma‐induced TS cases, one case which was reported later was excluded . In total, 156 cases reports (107 cases with PPGL‐induced TS, 42 cases epinephrine‐induced TS, and 7 cases norepinephrine‐induced TS) constitute the patient cohort for the meta‐analysis. Among the cases included were two non‐English case reports (one case in Swedish and one in German) where enough information could be obtained.…”

Section: Resultsmentioning

confidence: 99%

Clinical features, complications, and outcomes of exogenous and endogenous catecholamine‐triggered Takotsubo syndrome: A systematic review and meta‐analysis of 156 published cases

Y‐Hassan

Falhammar

2020

Clinical Cardiology

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Innumerable physical stress factors including externally administered catecholamines, and pheochromocytomas and paragangliomas (PPGLs) have been reported to trigger Takotsubo syndrome (TS). A systematic search of PubMed/MEDLINE identified 156 patients with catecholamine-induced TS up to December 2017. Data were compared within the catecholamine-induced TS cohort, but some comparisons were also done to a previously published large all-TS cohort (n = 1750). The mean age was 46.4 ± 16.4 years (72.3% women). The clinical presentation was dramatic with high complication rates in (68.2%, n = 103; multiple complications 34.6%, n = 54). The most common TS ballooning pattern was apical or mid-apical (45.2%, n = 69), followed by basal pattern (28.8%, n = 45), global pattern (16.0%, n = 25), midventricular (8.3%, n = 13), focal (0.6%, n = 1), and unidentified pattern (1.9%, n = 3).There was an increase in the prevalence of apical sparing ballooning pattern compared to all-TS population (37.7% vs 18.3%, P < .00001). Higher complication rates were observed in TS with global ballooning pattern compared to apical ballooning pattern (23/25, 92% vs 38/65, 58.5%; P = .0022). Higher complication rates were observed in patients with age < 50 years than patients >50 years (73/92, 79.3% vs 29/56, 51.8%, P = 0.0009). Recurrence occurred exclusively in patients with PPGLinduced TS (18/107 patients, 16.8%). PPGL-induced TS was characterized by more global ballooning's pattern (22/104, 21.2% vs 3/49, 6.1%, P = 0.02), and lower left ventricular ejection fraction (25.54 ± 11.3 vs 31.82 ± 9.93, P = 0.0072) compared to exogenous catecholamine-induced TS. In conclusion, catecholamine-induced TS was characterized by a dramatic clinical presentation with extensive left ventricular dysfunction, and high complication rate. K E Y W O R D S broken heart syndrome, epinephrine, myocardial stunning, norepinephrine, paraganglioma, pheochromocytoma, Takotsubo

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Section: Resultsmentioning

confidence: 99%

Clinical features, complications, and outcomes of exogenous and endogenous catecholamine‐triggered Takotsubo syndrome: A systematic review and meta‐analysis of 156 published cases

Y‐Hassan

Falhammar

2020

Clinical Cardiology

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“…This type of acute cardiomyopathy is not unusual in PCC and has been reported in <3% of patients. 8 This is a reversible form of cardiomyopathy that recovers completely after an acute attack if managed promptly. This apical ballooning syndrome (takotsubo cardiomyopathy) is thought to occur due to extreme coronary vasospasm by the circulating catecholamines.…”

Section: Discussionmentioning

confidence: 99%

von Hippel–Lindau Disease with Multi-organ Cysts and Ticking Pheochromocytoma: A Rare Case

Sadacharan¹,

Sathya²,

Rao³

et al. 2019

World Journal of Endocrine Surgery

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Objective: A rare disease. Background: von Hippel-Lindau (VHL) disease is an autosomal dominant familial syndrome with a multitude of benign and malignant multivisceral tumors and one-third of them harbor pheochromocytoma (PCC). We intend to present one such rare case and challenges in its surgical management. Case: A 38-year-old lady presented with hypertension and episodic headache. Biochemical evaluation was suggestive of hypercatecholaminism. Magnetic resonance imaging (MRI) showed the presence of a heterogeneous intensity lesion in the left suprarenal area suggestive of PCC. Multiple cysts were seen in both the kidneys as well as in the pancreatic head and tail. Imaging of the brain and spine showed a left cerebellar and spinal cord hemangioblastoma, respectively. I-131 metaiodobenzylguanidine (MIBG) showed high uptake in the left suprarenal region. After adequate preparation, she underwent left adrenalectomy. Histopathology was consistent with adrenal PCC and the patient was biochemically cured of hypercatecholaminism. The presence of PCC and other manifestations of VHL type 2A were evident in this patient. Conclusion:The presence of multiple renal and pancreatic cysts can camouflage adrenal tumors intraoperatively. Careful identification, dissection, and differentiation of PCC from these cysts are crucial. Multicentricity and multifocality of PCC are not uncommon in VHL and these patients need lifelong close follow-up for other tumors as well.

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“…Takotsubo cardiomyopathy has been found to be associated with physical and emotional triggers. Some of these stressors include pheochromocytoma, myocarditis, psychiatric illnesses, prolonged QT syndromes, COPD exacerbations, albuterol, hyperthyroidism, seizure disorders, electroconvulsive therapy, acute brain injury, and sepsis [6][7][8][9][10][11][12][13][14][15]. For this reason, the syndrome has also been referred to as "stress-induced" cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Management is generally conservative as most patients will make a full recovery. Left ventricular dysfunction tends to normalize after 7 days [6]. Treatment should begin with removal of any precipitating emotional, physical, and/or inciting stressor(s).…”

Section: Discussionmentioning

confidence: 99%

A Case of Recurrent Takotsubo Cardiomyopathy: Not a Benign Entity

et al. 2018

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Takotsubo cardiomyopathy is a relatively uncommon condition triggered by severe physical and/or emotional stress. It is characterized by transient ventricular wall dysfunction in the absence of coronary artery disease (CAD). Herein, we report a case of a 59-year-old female who had three episodes of recurrent Takotsubo cardiomyopathy. On each occasion, she presented with symptoms of acute coronary syndrome accompanied by left ventricular wall motion abnormalities; however, repeat cardiac catheterization failed to show CAD. Each recurrence resulted in resolution of her symptoms and recovery of left ventricular function. While emotional triggers were identified, on two occasions, the patient presented with ventricular fibrillation for which an implantable cardioverter defibrillator (ICD) was ultimately placed. We encourage clinicians to no longer look at Takotsubo cardiomyopathy as a benign, reversible disease process, but rather as a pathological entity with real, life-threatening complications that may be managed with ICD placement.

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Adrenal pheochromocytoma presenting with Takotsubo-pattern cardiomyopathy and acute heart failure

Cited by 21 publications

References 12 publications

Clinical features, complications, and outcomes of exogenous and endogenous catecholamine‐triggered Takotsubo syndrome: A systematic review and meta‐analysis of 156 published cases

Clinical features, complications, and outcomes of exogenous and endogenous catecholamine‐triggered Takotsubo syndrome: A systematic review and meta‐analysis of 156 published cases

von Hippel–Lindau Disease with Multi-organ Cysts and Ticking Pheochromocytoma: A Rare Case

A Case of Recurrent Takotsubo Cardiomyopathy: Not a Benign Entity

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