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Martha JW, Prameswari HS, Munita FF, Kusumawardhani NY, Hasan M, Astuti A, Mulyani NN, Agustina H, Sari MT. A multidisciplinary approach of a patient with pheochromocytoma presenting as recurrent acute fulminant myocarditis: A rare case report and comprehensive review of literature. Curr Probl Cardiol 2024; 49:102521. [PMID: 38492617 DOI: 10.1016/j.cpcardiol.2024.102521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
Fulminant myocarditis (FM) is a rare illness characterized by abrupt and severe widespread cardiac inflammation, which frequently results in mortality due to cardiogenic shock, ventricular arrhythmias, or multiorgan system failure. Pheochromocytoma is an uncommon and difficult-to-diagnose cause of FM, and it is associated with a significant risk of recurrent acute myocarditis. There is, however, little information on reoccurring acute FM. Herein, we report a rare case of recurrent acute FM due to pheochromocytoma. We present the case of a 22-year-old woman who was admitted to our hospital three days previously with acute dyspnea. Five months prior, the patient was diagnosed with post-acute myocarditis, and a massive tumor on the right adrenal gland was discovered, which lead to pheochromocytoma diagnosis. In this present admission, following the exclusion of infection, autoimmune, and metabolic derangements, pheochromocytoma was presumed to be the reason for the recurrence and more severe acute FM during the current hospitalization. The patient responded favorably to high-dose steroids combined with heart failure therapy regimens. To detect recurrent acute myocarditis related to pheochromocytoma, a multidisciplinary approach was used, including several laboratory biomarkers and imaging findings. Following pheochromocytoma removal and biopsy, the patient recovered satisfactorily. Our findings may provide beneficial contributions to the literature as pheochromocytoma is an uncommon but important cause of recurrent acute myocarditis. A multidisciplinary approach is essential in identifying acute FM and determining the underlying causes of this malady.
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Affiliation(s)
- Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University-Dr Hasan Sadikin Hospital, Jalan Prof Eyckman 38, Bandung, West Java 40161, Indonesia.
| | - Hawani Sasmaya Prameswari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University-Dr Hasan Sadikin Hospital, Jalan Prof Eyckman 38, Bandung, West Java 40161, Indonesia
| | - Fatihatul Firdaus Munita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University-Dr Hasan Sadikin Hospital, Jalan Prof Eyckman 38, Bandung, West Java 40161, Indonesia
| | - Nuraini Yasmin Kusumawardhani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University-Dr Hasan Sadikin Hospital, Jalan Prof Eyckman 38, Bandung, West Java 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Padjadjaran University-Dr Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Melawati Hasan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University-Dr Hasan Sadikin Hospital, Jalan Prof Eyckman 38, Bandung, West Java 40161, Indonesia
| | - Astri Astuti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University-Dr Hasan Sadikin Hospital, Jalan Prof Eyckman 38, Bandung, West Java 40161, Indonesia
| | - Nanny Natalia Mulyani
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University-Dr Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Hasrayati Agustina
- Department of Pathological Anatomy, Faculty of Medicine, Padjadjaran University-Dr Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Minsy Titi Sari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University-Dr Hasan Sadikin Hospital, Jalan Prof Eyckman 38, Bandung, West Java 40161, Indonesia
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De Angelis E, Bochaton T, Ammirati E, Tedeschi A, Polito MV, Pieroni M, Merlo M, Gentile P, Van De Heyning CM, Bekelaar T, Cipriani A, Camilli M, Sanna T, Marra MP, Cabassi A, Piepoli MF, Sinagra G, Mewton N, Bonnefoy-Cudraz E, Ravera A, Hayek A. Pheochromocytoma-induced cardiogenic shock: A multicentre analysis of clinical profiles, management and outcomes. Int J Cardiol 2023; 383:82-88. [PMID: 37164293 DOI: 10.1016/j.ijcard.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE There is still uncertainty about the management of patients with pheochromocytoma-induced cardiogenic shock (PICS). This study aims to investigate the clinical presentation, management, and outcome of patients with PICS. METHODS We collected, retrospectively, the data of 18 patients without previously known pheochromocytoma admitted to 8 European hospitals with a diagnosis of PICS. RESULTS Among the 18 patients with a median age of 50 years (Q1-Q3: 40-61), 50% were men. The main clinical features at presentation were pulmonary congestion (83%) and cyclic fluctuation of hypertension peaks and hypotension (72%). Echocardiography showed a median left ventricular ejection fraction (LVEF) of 25% (Q1-Q3: 15-33.5) with an atypical- Takotsubo (TTS) pattern in 50%. Inotropes/vasopressors were started in all patients and temporary mechanical circulatory support (t-MCS) was required in 11 (61%) patients. All patients underwent surgical removal of the pheochromocytoma; 4 patients (22%) were operated on while under t-MCS. The median LVEF was estimated at 55% at discharge. Only one patient required heart transplantation (5.5%), and all patients were alive at a median follow-up of 679 days. CONCLUSIONS PICS should be suspected in case of a CS with severe cyclic blood pressure fluctuation and rapid hemodynamic deterioration, associated with increased inflammatory markers or in case of TTS progressing to CS, particularly if an atypical TTS echocardiographic pattern is revealed. T-MCS should be considered in the most severe cases. The main challenge is to stabilize the patient, with medical therapy or with t-MCS, since it remains a reversible cause of CS with a low mortality rate.
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Affiliation(s)
- Elena De Angelis
- Department of Cardiology and Intensive Care Unit, "S. Anna e SS. Madonna della Neve" Boscotrecase Hospital, Local Health Authority Naples 3 South, Naples, Italy; Intensive Cardiological Care Division, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France.
| | - Thomas Bochaton
- Intensive Cardiological Care Division, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Enrico Ammirati
- "De Gasperis" Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Tedeschi
- "De Gasperis" Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Cardiology Division, Parma University, Parma University Hospital, Parma, Italy
| | - Maria Vincenza Polito
- Cardiology Division, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Maurizio Pieroni
- Cardiovascular Department, ASL8 Arezzo, "San Donato Hospital", Arezzo, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria "Giuliano Isontina" (ASUGI), University of Trieste, Trieste, Italy
| | - Piero Gentile
- "De Gasperis" Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Thalia Bekelaar
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Alberto Cipriani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Massimiliano Camilli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Martina Perazzolo Marra
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Aderville Cabassi
- Cardiorenal and Hypertension Research Unit, Physiopathology Unit, Clinica Medica Generale e Terapia Medica, Department of Medicine and Surgery (DIMEC), University of Parma, Parma, Italy
| | - Massimo F Piepoli
- Cardiology Department, Guglielmo da Saliceto Hospital of Piacenza, Piacenza, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria "Giuliano Isontina" (ASUGI), University of Trieste, Trieste, Italy
| | - Nathan Mewton
- Clinical Investigation Centre and Heart Failure Department, Hôpital Cardiovasculaire Louis Pradel, Inserm 1407, France
| | - Eric Bonnefoy-Cudraz
- Intensive Cardiological Care Division, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Amelia Ravera
- Intensive Cardiac Care Unit, Cardiology Division, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Ahmad Hayek
- Intensive Cardiological Care Division, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France; Interventional Department, Montreal heart Institute, Quebec, Canada
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Baio R, Pagano T, Molisso G, Di Mauro U, Intilla O, Albano F, Scarpato F, Giacometti S, Sanseverino R. When a Multidisciplinary Approach Is Life-Saving: A Case Report of Cardiogenic Shock Induced by a Large Pheochromocytoma. Diseases 2022; 10:29. [PMID: 35645250 PMCID: PMC9149903 DOI: 10.3390/diseases10020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pheochromocytoma is known for its instantaneous presentation, especially in the younger population. Hemodynamic instability may be the cause of severe complications and impede patients' ability to undergo surgical treatment. These tumours are surgically difficult to treat due to the risk of catecholamine release during their manipulations, and when they are large, the tumour size represents an additional challenge. In our report, cardiogenic shock developed due to increases in systemic vascular resistance, and the lesion's size induced surgeons to perform open surgery. CASE PRESENTATION A 46-year-old female patient was admitted to our intensive care unit with hypertension and later cardiogenic shock. Systolic dysfunction was noted, along with severely increased systemic vascular resistance. A CT scan showed a left-sided 8.5 cm adrenal mass, which was confirmed as pheochromocytoma using meta-iodobenzylguanidine scintigraphy. Anaesthesiologists and the surgical team planned an effective strategy of treatment. Given the lesion's size and its apparent invasion of the neighbouring organs, open adrenalectomy (after prolonged hemodynamic stabilisation) was considered safer. The surgery was successful, and the patient remains free from disease two years after the initial event. CONCLUSIONS Large pheochromocytoma can be safely and effectively treated with open surgery by experienced hands but only by seeking to reach hemodynamic stabilisation and minimising the release of catecholamine before and during surgery.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery “Scuola Medica Salernitana”, University of Salerno, I-84081 Salerno, Italy
| | - Tommaso Pagano
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Giovanni Molisso
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
| | - Umberto Di Mauro
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
| | - Olivier Intilla
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
| | - Francesco Albano
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Fulvio Scarpato
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Stefania Giacometti
- Departments of Anesthesiology, Umberto I Hospital, I-84014 Salerno, Italy; (T.P.); (F.A.); (F.S.); (S.G.)
| | - Roberto Sanseverino
- Department of Urology, Umberto I Hospital, I-84014 Salerno, Italy; (G.M.); (U.D.M.); (O.I.); (R.S.)
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Jenča D, Kubánek M, Kudla M, Solar N, Kautzner J. Adrenal pheochromocytoma as a rare cause of reversible left ventricular systolic dysfunction and malignant arrhythmias: a case series. Eur Heart J Case Rep 2022; 6:ytac098. [PMID: 35372755 PMCID: PMC8972823 DOI: 10.1093/ehjcr/ytac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/21/2021] [Accepted: 01/12/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Pheochromocytoma is a neuroendocrine tumour originating from the chromaffin cells of adrenal glands or sympathetic paraganglia. It produces most frequently norepinephrine, epinephrine, and dopamine. As a result of non-specific and variable clinical presentation, pheochromocytoma is difficult to diagnose.
Case summary
A 37-year-old female without medical history and 57-year-old male patient with diabetes, arterial hypertension, and aortic valve replacement with a mechanical prosthesis were admitted to the hospital after successful cardiopulmonary resuscitation due to ventricular fibrillation. In both patients, coronary angiography demonstrated a normal finding, and echocardiography showed left ventricular (LV) contractile dysfunction with improvement in the subsequent examination. In the first patient, the diagnosis of stress-induced cardiomyopathy was considered as the most probable cause. She was later admitted to hospital due to acute pulmonary oedema with hypertensive crisis. Echocardiography documented reversible LV systolic dysfunction with improvement after 3 days. The course of hospitalization of the male was complicated by multi-organ dysfunction syndrome comprising renal failure, paralytic ileus, and pancreatic irritation, which normalized after 2 weeks. The diagnosis of pheochromocytoma was confirmed by laboratory tests and imaging methods. After pharmacological pre-treatment with doxazosin in both patients and bisoprolol in the female, successful adrenalectomies were performed with no relapse of tumour.
Discussion
We describe an atypical clinical presentation of pheochromocytoma with initial cardiac arrest due to ventricular fibrillation and reversible LV systolic dysfunction. Our cases underline that clinical suspicion of pheochromocytoma as a potentially correctable cause should be raised in unexplained cases of severe heart failure, ventricular arrhythmias, and cardiac arrest.
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Affiliation(s)
- Dominik Jenča
- Department of Cardiology, Institute for Clinical and Experimental Medicine , Vídeňská 1958/9, Prague, Czech Republic
- Third Faculty of Medicine, Charles University , Prague, Czech Republic
| | - Miloš Kubánek
- Department of Cardiology, Institute for Clinical and Experimental Medicine , Vídeňská 1958/9, Prague, Czech Republic
| | - Michal Kudla
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine , Prague, Czech Republic
| | - Nevenka Solar
- Department of Nuclear Medicine, Institute for Clinical and Experimental Medicine , Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine , Vídeňská 1958/9, Prague, Czech Republic
- Faculty of Medicine and Dentistry, Palacký University , Olomouc, Czech Republic
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Rojbi I, Adel M, Affes M, Hantous S, Jrad M, Ben Nacef I, Khiari K. Pheochromocytoma presenting as fulminant myocarditis mimicking COVID-19 pneumonia. Clin Case Rep 2021; 9:e05046. [PMID: 34765217 PMCID: PMC8572347 DOI: 10.1002/ccr3.5046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/11/2021] [Accepted: 10/22/2021] [Indexed: 11/07/2022] Open
Abstract
Adrenergic cardiomyopathy is uncommon but can be fulminant and life-threatening. Nowadays, the need to exclude the possibility of COVID-19 pneumonia in patients with acute dyspnea in a previously healthy adult may cause a delay in the diagnosis.
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Affiliation(s)
- Imen Rojbi
- EndocrinologyCharles Nicolle HospitalTunisTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
| | - Meriem Adel
- EndocrinologyCharles Nicolle HospitalTunisTunisia
| | - Meriem Affes
- Medical ImagingHospital of Pneumo‐Phtisiology Abderrahman MamiArianaTunisia
| | - Saoussen Hantous
- Medical ImagingHospital of Pneumo‐Phtisiology Abderrahman MamiArianaTunisia
| | - Myriam Jrad
- Medical ImagingCharles Nicolle HospitalTunisTunisia
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Kissami I, Housni B, Jabi R, Bouziane M, Elouafi N, Ismaili N. Acute coronary syndrome: Uncommon presentation of multiple endocrine neoplasia. Int J Surg Case Rep 2021; 83:105926. [PMID: 33971553 PMCID: PMC8129923 DOI: 10.1016/j.ijscr.2021.105926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Myocardial infarction is usually due to thrombotic occlusion of a coronary vessel caused by rupture of a vulnerable atherosclerosis plaque. There is also the acute myocardial infarction with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction with non-obstructive coronary arteries (MINOCA) such as Takotsubo, myocarditis and catecholamine induced cardiomyopathy. Pheochromocytoma is one of the causes of MINOCA. This association is rare but it may delay diagnosis and must be known in order to provide the best chance at early detection. This work has been reported in the line with the SCARE criteria. PRESENTATION OF THE CASE We report a case of a 49 year-old man, admitted to our department for a recurrence of myocardial infarction with angiographically normal coronary arteries. During his hospitalization the patient complained of intestinal haemorrhage. The abdominal Computed tomographic scan revealed bilateral adrenal mass. The diagnosis of pheochromocytoma was made and confirmed by a high level of normetanephirnes and metanephrines. DISCUSSION The coexistence of multiple endocrine neoplasia type 2 and myocardial infarction appears to be a rare association rather than a coincidence. CONCLUSION In this case we highlight the importance of thorough history taking and investigation for the determining the aetiology of MINOCA. As a reversible cause of myocardial dysfunction, catecholamine-induced cardiomyopathy can occur as a feature of multiple endocrine neoplasia. The prognosis depends greatly on early diagnosis and prompt medical and surgical treatment, which are unfortunately often delayed because of the challenging diagnosis in many cases.
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Affiliation(s)
- Ibtissam Kissami
- Department of Cardiology, Mohamed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco.
| | - Brahim Housni
- Department of Critical Care and Anesthesiology, Mohamed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Rachid Jabi
- Department of General Surgery, Mohamed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Mohammed Bouziane
- Department of General Surgery, Mohamed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Nouha Elouafi
- Department of Cardiology, Mohamed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Nabila Ismaili
- Department of Cardiology, Mohamed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco; Laboratory of Epidemiology and Clinical Research, Faculty of Medicine and Pharmacy, Oujda, Morocco
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Zörner CR, Dixen U, Toft BG, Ynddal MS, Sommer P, Hove JD, Frydland MS. Pheochromocytoma induced cardiomyopathy in a young man: a case report. Oxf Med Case Reports 2021; 2021:omaa128. [PMID: 33542830 PMCID: PMC7846195 DOI: 10.1093/omcr/omaa128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/05/2020] [Accepted: 11/17/2020] [Indexed: 11/12/2022] Open
Abstract
Pheochromocytoma is a tumor arising from the adrenal medulla, most frequent benign and, due to the excretion of catecholamines, a rare cause of hypertension. The diagnosis of pheochromocytoma can be challenging because of its episodic nature, unspecific symptoms and rarity. Consequently, treatment can be delayed with serious consequences for the patient. We present a case report regarding a young man with episodes of severe hypertension over a period of at least 9 years. Ultimately, with a possible trigger effect from the intake of multiple energy drinks, the patient presented with severe hypertension, symptoms mimicking acute coronary syndrome, abnormal laboratory parameters and echocardiography suggestive of severe cardiomyopathy. The patient's pheochromocytoma was incidentally identified in a computed tomography scan during the initial workup. Although a rare condition, pheochromocytoma should be considered as a differential diagnosis, especially in young patients presenting with unexplained hypertension, chest pain and cardiac dysfunction.
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Affiliation(s)
| | - Ulrik Dixen
- Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark
| | | | | | - Peter Sommer
- Department of Urology, Rigshospitalet, Copenhagen, Denmark
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Maestroni U, Ziglioli F, Baciarello M, Bellini V, Dalla Valle R, Cataldo S, Maspero G, Bignami E. Multidisciplinary management of a large pheochromocytoma presenting with cardiogenic shock: a case report. BMC Urol 2019; 19:118. [PMID: 31747934 PMCID: PMC6868789 DOI: 10.1186/s12894-019-0554-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 11/08/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pheochromocytoma is well-known for sudden initial presentations, particularly in younger patients. Hemodynamic instability may cause serious complications and delay a patient's ability to undergo surgical resection. Larger tumors present a further challenge because of the risk of catecholamine release during manipulations. In the case we present, increases in systemic vascular resistance caused cardiogenic shock, and the size of the lesion prompted surgeons to veer off from their usual approach. CASE PRESENTATION A 38-year-old female patient was admitted to our intensive care unit with hypertension and later cardiogenic shock. Profound systolic dysfunction (left ventricular ejection fraction of 0.12) was noted together with severely increased systemic vascular resistance, and gradually responded to vasodilator infusion. A left-sided 11-cm adrenal mass was found with computed tomography and confirmed a pheochromocytoma with a meta-iodo-benzyl-guanidine scintigraphy. Surgical treatment was carefully planned by the endocrinologist, anesthesiologist and surgeon, and was ultimately successful. After prolonged hemodynamic stabilization, open adrenalectomy and nephrectomy were deemed safer because of lesion size and the apparent invasion of the kidney. Surgery was successful and the patient was discharged home 5 days after surgery. She is free from disease at almost 2 years from the initial event. CONCLUSIONS Large, invasive pheochromocytoma can be safely and effectively managed with open resection in experienced hands, provided all efforts are made to achieve hemodynamic stabilization and to minimize. Catecholamine release before and during surgery.
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Affiliation(s)
- Umberto Maestroni
- Department. of General and Specialty Surgery, Urology Unit, University Hospital of Parma, Parma, Italy
| | - Francesco Ziglioli
- Department. of General and Specialty Surgery, Urology Unit, University Hospital of Parma, Parma, Italy
| | - Marco Baciarello
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy.
| | - Valentina Bellini
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy
| | - Raffaele Dalla Valle
- Department of Medicine and Surgery, Hepatobiliary Surgery Unit, University of Parma, Parma, Italy
| | - Simona Cataldo
- Department of Medicine, Endocrinology and Metabolic Diseases Unit, University Hospital of Parma, Parma, Italy
| | - Giada Maspero
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy
| | - Elena Bignami
- Department of Medicine and Surgery, Anesthesia, Critical Care and Pain Medicine, University of Parma, Parma, Italy
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