Pheochromocytoma presenting after cardiac transplantation for dilated cardiomyopathy

Dalby, Miles; Burke, M.; Radley-Smith, R; Banner, Nicholas R.

doi:10.1016/s1053-2498(00)00233-3

Cited by 35 publications

(26 citation statements)

References 10 publications

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“…It has also been associated with the development of dilated cardiomyopathy, myocarditis, and heart failure. [1][2][3][4][5][6][7][8][9][10][11] Pheochromocytoma as a cause of systemic hypertension occurs in less than 1% of hypertensive patients. Surgical removal is curative in greater than 85% of cases.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…2,5 Pheochromocytoma presenting after cardiac transplantation for dilated cardiomyopathy has been reported. 2 In fact, successful reversal of catecholamine-induced cardiomyopathy resulting from the resection of a pheochromocytoma has been reported. 3,9 Pheochromocytomas are rarely associated with acute noncardiogenic pulmonary edema and catecholamine-induced cardiomyopathy as their first clinical manifestation.…”

Section: Discussionmentioning

confidence: 99%

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Presentation of an Unsuspected Pheochromocytoma as Acute Aortic Valvular Insufficiency and Diabetes Mellitus Type 2

Sinnott

Sarne

et al. 2006

The Endocrinologist

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We report the uncommon presentation of an unsuspected pheochromocytoma in a 76-year-old woman. Two years after surgery for acute aortic valve insufficiency and a diagnosis of diabetes, the patient presented with postural headaches, orthostatic dizziness, and palpitations. Physical examination confirmed intractable hypertension, orthostatic hypotension, and congestive heart failure secondary to progressive dilated cardiomyopathy. Based on her symptomatology, examination findings, and progressive dilated cardiomyopathy despite aortic valve replacement, a diagnosis of a pheochromocytoma was entertained. Twenty-four-hour urinary studies confirmed the presence of a catecholamine producing tumor. A magnetic resonance image revealed the presence of a 4.6-cm left adrenal mass, which characteristically enhanced on T2 imaging. After medical stabilization with phenoxybenzamine, she underwent a left robotic adrenalectomy. Histology confirmed a diagnosis of a pheochromocytoma. Two weeks later, she was normoglycemic and normotensive off all medications. The pheochromocytoma is a rare catecholamine-producing tumor, which can be lethal unless recognized and appropriately treated. A high degree of clinical suspicion is necessary, especially in the presence of confounding disease processes. A pheochromocytoma should be considered in the differential diagnosis of acute aortic valvular insufficiency in the setting of orthostatic hypotension, intractable hypertension, and newly diagnosed diabetes. Learning Objectives• Recall the presenting clinical features of this patient when seen 2 years after replacement of an insufficient aortic valve, emphasizing cardiovascular abnormalities. • Point out the lethality of unrecognized pheochromocytoma and diagnostic measures that may permit timely surgical treatment. • Explain relationships among hypersecretion of catecholamines by a pheochromocytoma, cardiovascular disease, and type 2 diabetes. P heochromocytoma presenting as aortic valve insufficiency, progressive dilated cardiomyopathy, orthostatic hypotension, and diabetes is uncommon. We report an unusual case of a 76-year-old woman with a recent history of acute aortic valvular insufficiency and diabetes mellitus type 2 who presented with congestive heart failure, orthostatic hypotension, and was subsequently found to have an unsuspected pheochromocytoma. She had rapid resolution of her intractable orthostatic hypotension, congestive heart failure, and diabetes after the surgical removal of the tumor. CASE REPORTA 76-year-old woman was first hospitalized 2 years before the present illness for the surgical repair of acute aortic valve insufficiency. At that time, she was simultaneously diagnosed with type 2 diabetes requiring oral medications. Her medical history was notable for uncontrolled hypertension. An echocardiogram revealed severe acute aortic valvular insufficiency with evidence of normal left ventricular size and function. Cardiac catheterization demonstrated no evidence of coronary artery disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Presentation of an Unsuspected Pheochromocytoma as Acute Aortic Valvular Insufficiency and Diabetes Mellitus Type 2

Sinnott

Sarne

et al. 2006

The Endocrinologist

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“…The chronic cardiomyopathy seems to depend on persistently high circulating levels of catecholamines because surgical removal of the tumor leads to significant improvement of cardiac function. [141][142][143][144] Autopsy studies have demonstrated the presence of myocarditis in about half of patients who die from pheochromocytoma. 143,145,146 Histologic findings include focal necrosis with infiltration of inflammatory cells, perivascular inflammation, and contraction band necrosis ( Fig.…”

Section: Pathophysiologymentioning

confidence: 99%

Endocrine Disorders and the Heart

Lavis¹,

Picolos²,

Willerson

2007

Cardiovascular Medicine

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“…Local overproduction of angiotensin II and norepinephrine is well known to facilitate LV remodeling, irrespective of the index event. Patients with pheochromocytoma can develop either dilated or hypertrophic cardiomyopathy [10]. These neurohormones are also directly toxic to cardiac myocytes.…”

Section: Neurohormonal Activationmentioning

confidence: 99%

Evolving concepts in left ventricular systolic and diastolic remodeling: Implications for therapy

Tang

Francis

2004

Curr Cardiol Rep

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Left ventricular (LV) remodeling describes dynamic changes in ventricular size and shape that result from hemodynamic and metabolic insults to the failing heart. The remodeling hypothesis in heart failure asserts that LV remodeling is the central pathophysiologic lesion whereby alterations in cardiac structure are followed by impairment in function, with a wide range of genetic-environment interactions that determine the ultimate phenotype. Several therapeutic targets of LV remodeling have already been exploited (such as neurohormonal and cytokine activation). On the other hand, great efforts are still being made to understand the complex array of genetic and metabolic derangements. Nevertheless, we have realized that there is no single phenotypic change, protein expression, or signal-transduction pathway that is dominant in the process of cardiac remodeling. This implies that better characterization of this heterogeneous heart failure phenotype is desperately needed.

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Pheochromocytoma presenting after cardiac transplantation for dilated cardiomyopathy

Cited by 35 publications

References 10 publications

Presentation of an Unsuspected Pheochromocytoma as Acute Aortic Valvular Insufficiency and Diabetes Mellitus Type 2

Presentation of an Unsuspected Pheochromocytoma as Acute Aortic Valvular Insufficiency and Diabetes Mellitus Type 2

Endocrine Disorders and the Heart

Evolving concepts in left ventricular systolic and diastolic remodeling: Implications for therapy

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