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Adrenergic cardiomyopathy and cardiogenic shock as initial presentation of pheochromocytoma. A case report and review of the literature
Gil-Barrionuevo, Esther (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Balibrea, José Maria (Hospital Universitari Vall d'Hebron)
Caubet, Enric (Universitat Autònoma de Barcelona. Departament de Cirurgia)
González López, Óscar (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Vilallonga, Ramón (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Fort, José Manuel (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Ciudin, Andrea (Universitat Autònoma de Barcelona. Departament de Biologia Cel·lular, de Fisiologia i d'Immunologia)
Armengol, Manel (Hospital Universitari Vall d'Hebron)
Hospital Universitari Vall d'Hebron

Fecha: 2018
Resumen: 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. 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. 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.
Derechos: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades. Creative Commons
Lengua: Anglès
Documento: article ; altres ; publishedVersion
Materia: Catecholamine-induced cardiomyopathy ; Pheocromocytoma ; Adrenergic myocarditis ; Case report
Publicado en: International Journal of Surgery Case Reports, Vol. 49 (june 2018) , p. 145-148, ISSN 2210-2612

DOI: 10.1016/j.ijscr.2018.06.024
PMID: 30007262


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