Diaz B, Elkbuli A, Ehrhardt JD, McKenney M, Boneva D, Hai S. Pheochromocytoma-related cardiomyopathy presenting as broken heart syndrome: Case report and literature review.
Int J Surg Case Rep 2019;
55:7-10. [PMID:
30641325 PMCID:
PMC6330378 DOI:
10.1016/j.ijscr.2018.12.003]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/08/2018] [Indexed: 12/14/2022] Open
Abstract
This is a case report of a rare adrenal tumor that manifested as acute coronary syndrome.
Adrenalectomy for pheochromocytoma presents a risk for intraoperative hemodynamic instability.
Preoperative medical care is essential to reduce intraoperative complications.
This case exemplifies the importance of the various symptoms that are prevalent with excessive circulating adreno-receptor agents.
Introduction
Pheochromocytoma are neuroendocrine tumors that arise from sympathetic chromaffin cells within the adrenal medulla. They principally secrete catecholamines, potentially causing life-threatening cardiovascular complications. A myriad of symptomatology and clinical findings are associated with pheochromocytoma, including a catecholamine-induced dilated cardiomyopathy.
Presentation of case
A 50-year-old woman presented with retrosternal chest pain and underwent diagnostic evaluation for acute coronary syndrome. Cardiac catheterization demonstrated patent coronary arteries and a pattern of ventricular hypokinesis consistent with takotsubo cardiomyopathy, also known as broken heart syndrome. Further imaging with abdominal CT revealed an adrenal mass. Laboratory markers supported the clinical picture of pheochromocytoma. Right adrenalectomy was performed and our patient was symptom-free at discharge on post-operative day three.
Discussion
Alpha and beta adrenergic blockade are used in a critical care setting to prevent perioperative hemodynamic instability as well as catecholamine-induced heart failure in the setting of pheochromocytoma. Patients commonly require vasopressors in the postoperative period due to the rapid reduction in circulating catecholamines following resection. Discharge planning should include recommendations for genetic counseling to screen for syndromic causes of pheochromocytoma that increase the risk for other neoplasms.
Conclusion
We present a case report of a rare adrenal tumor in a middle-aged woman that manifested as acute coronary syndrome. A presumptive diagnosis of takotsubo cardiomyopathy on cardiac catheterization led to further investigation. Abdominal imaging located an adrenal mass that correlated with laboratory studies positive for high levels of catecholamines and their metabolites. The tumor was excised and the patient recovered without complications.
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