Pheochromocytoma-related cardiomyopathy presenting as broken heart syndrome: Case report and literature review

Diaz, Brandon; Elkbuli, Adel; Ehrhardt, John D.; McKenney, Mark; Boneva, Dessy; Hai, Shaikh

doi:10.1016/j.ijscr.2018.12.003

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…4 TLC is being increasingly recognised as a presentation for catecholamine-secreting tumours. [5][6][7] In an analysis of 80 published cases of pheo-TLC worldwide, comparison was made with all cause TLC and following were the salient features: female predominance, relatively younger age at presentation, basal segments' involvement in 30%, global involvement in 20%, higher complication rate and recurrence rate than all cause TLC and no mortality difference between the two groups. Age less than 50 years and global and basal segmental wall motion abnormalities were identified as risk factors for complications.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Like Cardiomyopathy with Concomitant Pheochromocytoma: A Rare Presentation

2022

J Coll Physicians Surg Pak

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Pheochromocytoma classically presents with headache, diaphoresis, palpitations and, raised blood pressure. Rarely, it manifests as cardiomyopathy. Herein, we present a case of a 42-year woman who presented with heart failure and on work-up was found to have pheochromocytoma leading to Takotsubo-like cardiomyopathy. The biochemical profile revealed raised serum metanephrines and normetanephrines. CT abdomen showed a left adrenal mass. Within two weeks of presentation and before surgical excision of the mass, she recovered from cardiomyopathy. After medical optimisation, the patient underwent elective adrenalectomy, which on histological evaluation revealed pheochromocytoma.

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Section: Discussionmentioning

confidence: 99%

Takotsubo Like Cardiomyopathy with Concomitant Pheochromocytoma: A Rare Presentation

2022

J Coll Physicians Surg Pak

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“…We noted that most of such patients had few significant coronary atherosclerosis in past reports[ 8 - 10 ]. Most reports suggested that cardiomyopathy, severe coronary vasospasm, myocarditis, and tachycardia caused by excessive release of catecholamines result in elevated cardiac troponin and reduced left ventricular systolic function[ 11 , 12 ]. This case illustrates pheochromocytoma as one of the differential diagnoses for myocardial infarction with nonobstructed coronary arteries, especially in patients with unexplained erratic blood pressure and symptoms suggestive of pheochromocytoma.…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma as a cause of repeated acute myocardial infarctions, heart failure, and transient erythrocytosis: A case report and review of the literature

Shi

Sun

Long

et al. 2021

WJCC

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BACKGROUND Pheochromocytoma is a rare catecholamines-secreting tumor arising from chromaffin cells in the adrenal medulla. It classically presents with paroxysmal hypertension, headaches, palpitations, sweating, and metabolic disorders. Atypical presentations such as acute myocardial infarction, heart failure, cardiomyopathy, stroke, and transient erythrocytosis have been infrequently documented. CASE SUMMARY We describe the case of a 72-year-old man diagnosed with pheochromocytoma presenting with non-ST segment elevation myocardial infarction, heart failure, and transient erythrocytosis with nonobstructed coronary arteries. This was his second heart attack. The patient was previously diagnosed with myocardial infarction, and an immense mass was found on the left adrenal gland 3 years prior. Based on clinical and laboratory findings, a diagnosis of pheochromocytoma was confirmed. His coronary angiogram showed nonobstructed coronary arteries except for a myocardial bridge in the left anterior descending branch. This was a form of type-2 myocardial infarction. The myocardial cell lesions were caused by sudden secretion of catecholamines by the pheochromocytoma. Even more atypically, his hemoglobin level was obviously elevated at admission, but after a few days of treatment with an alpha-adrenergic receptor blocker, it dropped to normal levels without additional treatment. CONCLUSION Pheochromocytoma may be a cause of acute myocardial infarction, heart failure, and transient erythrocytosis.

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“…The emergence of TS is associated with over-activation of the adrenergic system [ 111 ]. Indeed, TS is often seen in patients with pheochromocytoma [ 112 - 114 ]. There are cases of TS after an injection of adrenergic receptor (AR) agonists [ 115 - 117 ].…”

Section: Etiology Of Takotsubo Syndromementioning

confidence: 99%

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

Прокудина

Kurbatov

Zavadovsky

et al. 2021

CCR

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: The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart, lack of coronary artery obstruction, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old , than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. In many patients with TS, but not in all, physical or emotional stress precedes the disease. Many patients with TS, but not all, have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with the excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β2 adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using 125I-metaiodobenzylguanidine (125I –MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS.

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Pheochromocytoma-related cardiomyopathy presenting as broken heart syndrome: Case report and literature review

Cited by 7 publications

References 22 publications

Takotsubo Like Cardiomyopathy with Concomitant Pheochromocytoma: A Rare Presentation

Takotsubo Like Cardiomyopathy with Concomitant Pheochromocytoma: A Rare Presentation

Pheochromocytoma as a cause of repeated acute myocardial infarctions, heart failure, and transient erythrocytosis: A case report and review of the literature

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

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