Giant Paraganglioma Complicated With Catecholamine Crisis and Catecholamine Cardiomyopathy: A Case Report and Review of the Literature

Abstract

BackgroundPheochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumors which overproduce catecholamines. Heart failure and myocardial infarction caused by paraganglioma complicated with catecholamine crisis are the most common causes of death in PPGL patients before surgery. When giant paraganglioma is complicated with catecholamine crisis, treatment brooks no delay.Case SummaryA 49-year-old man had episodic sweating, tachycardia with irregular pulse, and headaches 5 days before, and then showed up with chest pain and wheezing for 1 day. Meanwhile, he developed symptoms of recurrent severe abdominal pain and loss of consciousness, and his blood pressure was severely unstable (from 70/40 to 300/200 mmHg). First, the electrocardiogram showed ventricular tachycardia, and then we noticed the waves of ST-segment elevation, but we did not find significant abnormalities in coronary angiography. Abdominal CT and MRI revealed a giant lesion with bleeding or infection in the retroperitoneal adrenal area. These imaging findings were confirmed during surgery, and there was vascular adhesion between the retroperitoneal tumor and the inferior vena cava and left and right renal vein. After the successful resection of the tumor, postoperative pathology confirmed paraganglioma, and the patient pulled through and was discharged quickly.DiscussionThis is a rare case of giant paraganglioma complicated with catecholamine crisis and catecholamine cardiomyopathy. We can diagnosis this disease greatly by elevated norepinephrine, and it is a gold biochemical standard at present. Standard treatment is surgical resection, which is effective in treating this rare neuroendocrine tumor.

Successful surgical treatment of asymptomatic giant pheochromocytoma. Clinical case

“…Необходимо отметить, что выполнение биопсии при подозрении на ФХЦ/ПГ в большинстве случаев не показано по причине малой информативности и, самое главноеразвития возможных осложнений (диссеминация опухоли, гипертонический криз) [7]. Также перед выполнением хирургического лечения требуется специальная медикаментозная подготовка пациента a-адреноблокаторами не менее чем за 10-14 дней до операции, так как хирургическое удаление опухоли может сопровождаться резким выбросом в кровь большого количества катехоламинов, что без должной подготовки может привести к очень грозному осложнению -интраоперационной неконтролируемой гипертензии [8,9]. В рассматриваемом случае течение заболевания было абсолютно бессимптомным, что позволило нам избежать возможных осложнений как на дооперационном этапе, так и во время операции.…”

A Late-Detected Paraganglioma in a Young Patient with Resistant Hypertension and Severe Aortic Regurgitation—A Case Report and Review of the Literature

“…A massive surge of catecholamines can lead to the development of a life-threatening complication of PPGLs, known as a catecholamine crisis. The excessive serum concentration of active sympathetic amines produces unstable BP values and cardiovascular collapse in the form of heart failure and pulmonary edema, increasing the mortality risk in patients with undiagnosed PPGLs [11,12]. This hypertensive crisis may be triggered by psychological stressors; severe pain; situations related to anesthesia, such as induction or intubation; mechanical stimuli; or drugs that interact with adrenergic signaling, such as dopamine receptor antagonists, antidepressants, beta-blockers, or sympathomimetics [4].…”

Unusually large paraganglioma complicated with successive catecholamine crises: A case report and review of the literature

“…Clinical symptoms include hypertension, tachycardia, headache, sweating, etc. The intermittent nature of these symptoms often leads to a delay in the diagnosis ( 2 ). Paraganglioma can cause catecholamines cardiomyopathy including myocardial infarction, heart failure, and arrhythmia ( 2 ).…”

“…The intermittent nature of these symptoms often leads to a delay in the diagnosis ( 2 ). Paraganglioma can cause catecholamines cardiomyopathy including myocardial infarction, heart failure, and arrhythmia ( 2 ). Catecholamine crisis is an uncommon and dreaded complication.…”