Adrenergic cardiomyopathy and cardiogenic shock as initial presentation of pheochromocytoma. A case report and review of the literature. (2018)

• Record Type: Journal Article
• Authors: Gil-Barrionuevo, Esther; Balibrea, José Maria; Caubet, Enric; Gonzalez, Oscar; Vilallonga, Ramón; Fort, José Manuel; Ciudin, Andrea; Armengol, Manel
• Is Part Of: International journal of surgery case reports. Volume 49(2018)
• Page Start: 145
• Page End: 148
• Publication Date: 2018
• Subjects: Catecholamine-induced cardiomyopathy -- Pheocromocytoma -- Adrenergic myocarditis -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2018.06.024
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Adrenergic hyperstimulation states can lead to different grades of myocardial dysfunction. Cardiomyopathy of unknown origin can be caused by an underlying pheochromocytoma. The onset of adrenergic myocardiopathy as cardiogenic shock is exceptional. The reversibility of myocardial affection is common after pheochromocytoma resection. Delayed phechromocytoma resection may lead to irreversible cardiac affection and death. Abstract: Introduction: Pheochromocytomas are infrequent tumors arised from the chromaphine cells of the adrenal sympathetic system. The excess of circulating catecholamines may lead to different cardiovascular disorders from silent alterations of the myocardial conduction to different forms of cardiomyopathy. The onset as cardiogenic shock is exceptional. Presentation of case: A 35—year-old male, with a known history of acute myopericarditis of unknown origin which debuted as acute pulmonary edema, was admitted with dyspnea in the context of a new heart failure episode with pulmonary edema. An initial ECG showed segmentary repolarization changes, reversed in subsequent ECGs. The echocardiogram showed severe left ventricular dysfunction and lateral and apical hypokinesia. Subsequent echocardiograms showed partial recovery of alterations and preserved systolic function. A cardiac MRI showed a subepicardial minimum catchment focus and myocardial edema suggestive of adrenergic myocarditis. A solid nodular lesion was found in the left adrenal gland, suggesting a pheochromocytoma. Laparoscopic left adrenalectomy confirmed a 30 mm adrenal tumor without signs of locoregional invasion. The patient had normal catecholamine excretion and heart function a few weeks after surgery. Histopathology confirmed the diagnosis of pheochromocytoma. Discussion and conclusions: Adrenergic cardiomyopathy is a rare entity with a variable clinical presentation. The onset as cardiogenic shock is exceptional. The differential diagnosis of a patient with cardiogenic shock of unknown origin should consider the presence of an underlying pheocromocytoma as well as other states of adrenergic hyperstimulation. The reversibility of the myocardial affection in pheocromocytoma-associated myocardiopathy is common after the tumor resection.