Pheochromocytoma-Related Cardiomyopathy
2006; Lippincott Williams & Wilkins; Volume: 113; Issue: 17 Linguagem: Inglês
10.1161/circulationaha.105.581108
ISSN1524-4539
AutoresÁngel Sánchez‐Recalde, Olga Costero, José M. Oliver, Cristian Iborra, Elena Ruíz, José A. Sobrino,
Tópico(s)Neurosurgical Procedures and Complications
ResumoHomeCirculationVol. 113, No. 17Pheochromocytoma-Related Cardiomyopathy Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBPheochromocytoma-Related CardiomyopathyInverted Takotsubo Contractile Pattern Angel Sanchez-Recalde, MD, Olga Costero, MD, José M. Oliver, MD, Cristian Iborra, MD, Elena Ruiz, MD and José A. Sobrino, MD Angel Sanchez-RecaldeAngel Sanchez-Recalde From the Departments of Cardiology (A.S.-R., J.M.O., C.I., J.A.S.), Nephrology (O.C.), and Pathology and Anatomy (E.R.), La Paz University Hospital, Madrid, Spain. , Olga CosteroOlga Costero From the Departments of Cardiology (A.S.-R., J.M.O., C.I., J.A.S.), Nephrology (O.C.), and Pathology and Anatomy (E.R.), La Paz University Hospital, Madrid, Spain. , José M. OliverJosé M. Oliver From the Departments of Cardiology (A.S.-R., J.M.O., C.I., J.A.S.), Nephrology (O.C.), and Pathology and Anatomy (E.R.), La Paz University Hospital, Madrid, Spain. , Cristian IborraCristian Iborra From the Departments of Cardiology (A.S.-R., J.M.O., C.I., J.A.S.), Nephrology (O.C.), and Pathology and Anatomy (E.R.), La Paz University Hospital, Madrid, Spain. , Elena RuizElena Ruiz From the Departments of Cardiology (A.S.-R., J.M.O., C.I., J.A.S.), Nephrology (O.C.), and Pathology and Anatomy (E.R.), La Paz University Hospital, Madrid, Spain. and José A. SobrinoJosé A. Sobrino From the Departments of Cardiology (A.S.-R., J.M.O., C.I., J.A.S.), Nephrology (O.C.), and Pathology and Anatomy (E.R.), La Paz University Hospital, Madrid, Spain. Originally published2 May 2006https://doi.org/10.1161/CIRCULATIONAHA.105.581108Circulation. 2006;113:e738–e739A 41-year-old woman with no history of cardiac disease or hypertension was admitted to the intensive care unit with acute headache, psychomotor agitation, diaphoresis, nausea, and vomiting. A cerebral computed tomography scan ruled out subarachnoid hemorrhage. The ECG showed sinus tachycardia with ST-segment depression in leads V3–V6, II, III, and aVF. The troponin I level was elevated. The patient continued to have progressive respiratory deterioration, which required mechanical ventilation 24 hours after admission. She also developed 6 episodes of electromechanical dissociation, with circulatory recovery after successful cardiopulmonary resuscitation. Transthoracic echocardiography revealed severe left ventricular dysfunction and a contractile abnormality, consisting of akinesis of the basal and midventricular segments and hyperkinesis of the apical segments (Figure 1 and Movie I in the online Data Supplement). Emergency coronary angiography showed normal coronary arteries (Figure 2). The patient was stabilized after placement of an intra-aortic balloon pump and initiation of dobutamine and noradrenaline infusions, the latter being maintained for 6 days. A computed tomography scan of the abdomen revealed a right adrenal mass, and an α-adrenergic blocker was started, with the presumptive diagnosis of pheochromocytoma. The patient underwent an uncomplicated adrenalectomy on day 16 (Figure 3). Histological and immunohistochemical analyses confirmed the initial diagnosis (Figure 4). Echocardiography repeated on day 14 after surgery showed a left ventricular ejection fraction of 55% (Figure 5 and online Movie II). The patient is alive and remains asymptomatic 2 years after the operation. Download figureDownload PowerPointFigure 1. Subcostal long-axis (4-chamber) view, showing akinesis of the basal and midventricular segments, with preserved contractility of the apical segments. A, Diastole. B, Systole.Download figureDownload PowerPointFigure 2. Coronary angiograms did not show any coronary artery disease.Download figureDownload PowerPointFigure 3. Macroscopic examination of the tumor (2.5×3×2 cm) contained areas of necrosis and hemorrhage within the left adrenal gland.Download figureDownload PowerPointFigure 4. A, Hematoxylin and eosin staining reveals polygonal cells with fibrous tracts between them. B, Chromogranin staining was positive.Download figureDownload PowerPointFigure 5. Apical 4-chamber view shows a normal ejection fraction on day 14 after surgery. A, Diastole. B, Systole.Stress-related cardiomyopathy, or Takotsubo cardiomyopathy, is a well-described entity characterized by a typical contractile abnormality consisting of apical and midventricular akinesis or dyskinesis and hyperkinesis of the base. Severe generalized hypokinesis and Takotsubo left ventricular dysfunction have been described in pheochromocytoma-related cardiomyopathy.1 The physiopathologies of the 2 conditions, stress-induced cardiomyopathy and pheochromocytoma-induced cardiomyopathy, are believed to be similar and mediated by catecholamines.2 The patient had severe left ventricular dysfunction with different contractile abnormalities: The basal and midventricular segments were akinetic, whereas the apex showed hyperkinesis. Therefore, there is no unique ventricular dysfunction pattern in catecholamine-related cardiomyopathy.The mechanism underlying the association between catecholamines and myocardial injury is unknown. Our patient did not show spontaneous coronary vasoconstriction, and coronary flow was normal during cardiac catheterization, which was performed when the patient presented with hemodynamic instability. Therefore, direct myocyte injury was a possible mechanism of myocardial stunning.The online-only Data Supplement, which contains 2 movie files, can be found at http://circ.ahajournals.org/cgi/content/full/113/17/e738/DC1.DisclosuresNone.FootnotesCorrespondence to Dr Angel Sanchez-Recalde, Unidad de Hemodinámica y Cardiología Intervencionista, Planta 1A Diagonal, Servicio de Cardiología, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. E-mail [email protected]References1 Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Sasaka K. Reversible left ventricular dysfunction 'Takotsubo' cardiomyopathy related to catecholamine cardiotoxicity. J Electrocardiol. 2002; 35: 351–356.CrossrefMedlineGoogle Scholar2 Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005; 352: 539–548.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Chen M, Zhao T, Chen G and Hu S (2020) A rare long-term undetected pheochromocytoma leading to Takotsubo syndrome in an older male patient: a case report, BMC Endocrine Disorders, 10.1186/s12902-020-00578-5, 20:1, Online publication date: 1-Dec-2020. Santos J, Brofferio A, Viana B and Pacak K (2018) Catecholamine-Induced Cardiomyopathy in Pheochromocytoma: How to Manage a Rare Complication in a Rare Disease?, Hormone and Metabolic Research, 10.1055/a-0669-9556, 51:07, (458-469), Online publication date: 1-Jul-2019. 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Weber B, Lackner I, Gebhard F, Miclau T and Kalbitz M (2021) Trauma, a Matter of the Heart—Molecular Mechanism of Post-Traumatic Cardiac Dysfunction, International Journal of Molecular Sciences, 10.3390/ijms22020737, 22:2, (737) May 2, 2006Vol 113, Issue 17 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.105.581108PMID: 16651478 Originally publishedMay 2, 2006 PDF download Advertisement SubjectsAcute Coronary SyndromesCardiomyopathyCardiopulmonary Resuscitation and Emergency Cardiac CareCongenital Heart DiseaseContractile FunctionCoronary CirculationEchocardiographyImaging
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