Pheochromocytoma: cyclic attacks of hypertension alternating with hypotension

Kobal, Sergio; Paran, Esther; Jamali, Aamer; Mizrahi, Shlomo; Siegel, Robert J.; Leor, Jonathan

doi:10.1038/ncpcardio1054

Cited by 32 publications

(20 citation statements)

References 15 publications

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“…There are case reports describing alternating cycles of hypertension and hypotension as a manifestation of pheochromocytoma. 3,4 To our knowledge, the short cyclic intervals seen in our case have not been reported before. A similar case reported by Otsuka et al 5 showed a periodic fluctuation of blood pressure with cyclic changes at 20 min intervals and transient LV apical ballooning in pheochromocytoma.…”

supporting

confidence: 43%

Asymmetric blood pressure caused by extremely rapid cyclic fluctuations and reversible cardiomyopathy in pheochromocytoma

et al. 2012

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supporting

confidence: 43%

Asymmetric blood pressure caused by extremely rapid cyclic fluctuations and reversible cardiomyopathy in pheochromocytoma

et al. 2012

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“…[45] As with paroxysmal hypertension, these patients had tumors which secreted primarily epinephrine. [46] While the pathophysiology for this event is unclear, it is suggested that baroreceptors respond to a rapid rise in BP during acute paroxysm with activation of the negative feedback loop via both the sympathetic and parasympathetic systems, causing a rapid decrease in BP. [45-46]…”

Section: Clinical Pattern Of Pheochromocytoma-related Hypertensionmentioning

confidence: 99%

Hypertension in Pheochromocytoma: Characteristics and Treatment

Zuber

Kantorovich

Pacák

2011

Endocrinology and Metabolism Clinics of North America

168

107

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“…Oishi et al have reported treating a similar case successfully with a selective α-blocker ( 7 ). Kobal et al , in a study of nine cases, have reported the use of α-blockers in all cases and their effectiveness in controlling BP fluctuation in five of the nine cases ( 8 ). Recently, Ionescu et al have reported the successful treatment of pheochromocytoma with rapid alternating cycles of hypertension and hypotension using metirosine administration that inhibited catecholamine synthesis ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma crisis with cyclic fluctuation in blood pressure mimics acute coronary syndrome

Kometani

Yoneda

Maeda

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Pheochromocytoma crisis results from the sudden release of large quantities of catecholamines and leads to progressive multiple organ dysfunction. Here we report a case of pheochromocytoma crisis with symptoms associated with acute coronary syndrome (ACS) and severe fluctuations in blood pressure (BP). A 43-year-old Japanese man with hypertension (240/120 mmHg) visited a general hospital for chest pain. Echocardiogram showed ST segment depression and blood test demonstrated elevated troponin T. However, emergent coronary angiography revealed normal findings. CT showed a large adrenal mass on the left side, which was suspected as the cause of chest pain and BP elevation. After the patient was transported to our hospital, his BP was found to oscillate between 70 and 240 mmHg, and level of consciousness was decreased. After hospitalization, he had a further decrease in consciousness, a rise in body temperature, and a gradual increase in the interval between the upper and lower systolic BP. His systolic BP varied between 30 mmHg and 300 mmHg at the intervals of 20-30 min. After a multimodality therapy, including α-blocker and high dose fluid replacement, the fluctuation in his BP was gradually decreased and got stabilized after approximately 24 h. Approximately 3 weeks later, he underwent left adrenalectomy. This case showed that pheochromocytoma with internal necrosis might be misdiagnosed as ACS. Furthermore, in cases with a large adrenal tumor and severe elevation or fluctuations of BP, pheochromocytoma should be suspected and treated with α-blockers and fluid replacements as soon as possible prior to surgery. Learning points: High catecholamine levels due to pheochromocytoma crisis might cause symptoms associated with acute coronary syndrome. Adrenal tumor with internal necrosis and the elevation or fluctuations of blood pressure should be suspected to be pheochromocytoma. If pheochromocytoma crisis is suspected, the specialist, such as an endocrinologist or a urologist, should intervene, and an α-blocker treatment with adequate fluid replacement therapy should be initiated as soon as possible. Pheochromocytoma multisystem crisis (PMC) is a fatal condition characterized by multiple organ failure, severe blood pressure variability, high fever, and encephalopathy. This is an extremely rare subtype of a very rare disease such as pheochromocytoma. However, because the fatality rate of PMC is high, clinicians should be aware of the symptoms that mark its onset.

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Pheochromocytoma: cyclic attacks of hypertension alternating with hypotension

Abstract: Intravenous phentolamine and fluids, oral doxazosin and surgical removal of the tumor.

Cited by 32 publications

References 15 publications

Asymmetric blood pressure caused by extremely rapid cyclic fluctuations and reversible cardiomyopathy in pheochromocytoma

Asymmetric blood pressure caused by extremely rapid cyclic fluctuations and reversible cardiomyopathy in pheochromocytoma

Hypertension in Pheochromocytoma: Characteristics and Treatment

Pheochromocytoma crisis with cyclic fluctuation in blood pressure mimics acute coronary syndrome

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