Fatal Catecholamine-Induced Cardiotoxicity Associated with Pheochromocytoma: Report of a Postpartum Case and Review of the Literature

Abstract

Pheochromocytomas and paragangliomas are catecholamine-secreting tumors characterized by excessive adrenergic stimulation. Common manifestations include hypertension, headache, sweating, and palpitations; however, rare life-threatening conditions have also been reported and include cardiovascular shock, myocardial infarction, arrhythmias, and cardiomyopathy. We report a case of a previously healthy 31-year-old postpartum female presenting with headache who died suddenly in an emergency room. Autopsy revealed a pheochromocytoma of the right adrenal with significantly elevated metanephrine concentrations and acute "myocarditis." Sudden excessive catecholamine release can cause cardiovascular complications and be rapidly fatal without significant elevation of blood pressure. Awareness of this association by the medical examiner/coroner is vital in order to properly classify the death and apprise relatives of the potential utility of genetic screening.

Статеві Відмінності Вільнорадикальних Процесів У Міокарді При Ушкодженні Адреналіном На Тлі Світлової Депривації

“…У генезі їх розвитку важливе місце відводять стресу як фактору ризику, ініціація якого передбачає патогенний вплив адреналіну [1][2][3]. адреналін має як прямий негативний вплив на міокард, так і опосередкований суттєвими порушеннями метаболізму, що призводить до незворотного ушкодження кардіоміоцитів [4,5]. Визна-чальним за таких умов є стан антиоксидантної системи, активність якої залежить від швидкості та інтенсивності утворення вільнорадикальних сполук і швидкості використання проміжних продуктів пероксидного окиснення ліпідів (ПОл) у синтезі біологічно активних речовин у ділянці ушкодження [1,6].…”

Catecholamines Are the Key Trigger of COVID-19 mRNA Vaccine-Induced Myocarditis: A Compelling Hypothesis Supported by Epidemiological, Anatomopathological, Molecular, and Physiological Findings

“…Overall, the injury pattern in all three cases was consistent with stress cardiomyopathy with contraction bands caused by excessive catecholaminergic activity (i.e., hyperadrenergic, “hypernoradrenergic,” or both). These histopathological findings are exceedingly similar to the non-rare myocarditis complication of pheochromocytoma, a catecholamine-producing tumor in the adrenal medulla due to abnormal chromaffin cell proliferation [ 26 - 28 ].…”

Antioxidant and anti-cytolytic activity of parsnip (Pastinaca sativa L.) herb thick extract in conditions of catecholamine myocardiodystrophy in rats

“…It is known that adrenaline in high doses has an excessive stimulating effect on the myocardium, which leads to increased oxygen demand, hypoxia, ischemia, disorders of plastic and energy metabolism in the myocardium [3,4]. Violations of lipid metabolism in the myocardium, increased lipotoxicity [5], which creates conditions for disruption in the LPO / AOP system [6,7], as evidenced by increased TBA LPO and decreased levels of the antioxidant system RG in the myocardium of rats from PC.…”

“…In the genesis of their development, an important place is given to stress as a risk factor, the initiation of which involves the pathogenic effects of catecholamines, namely adrenaline [1,2]. Adrenaline has both a direct negative effect on the myocardium and mediated by significant metabolic disorders, which leads to irreversible damage to cardiomyocytes [3,4]. Superphysiological levels of catecholamines in blood plasma, above all, contributes to the violation of myocardial lipid homeostasis and causes disruption of lipid metabolism in the heart, which in turn enhances lipotoxicity and lipid peroxidation (LPO) [5].…”