Acute myocardial infarction due to pheochromocytoma
Main Article Content
Keywords
Pheochromocytoma, Myocardial infarction, Catecholamines
Abstract
Background: pheochromocytoma is a neuroendocrine tumor that secretes high levels of catecholamines and it is able to exert serious cardiovascular effects. The cardiac involvement is the most frequent, with reported conditions such as transient myocardial dysfunction, acute coronary syndrome and ventricular arrhythmias.
Clinical case: we reported a 36 year-old woman without cardiovascular history. She presented with an adrenergic crisis after surgery leading to acute heart failure and acute myocardial infarction. The electrocardiogram showed an ST-segment elevation and positive enzymatic curve, motion alterations in echocardio-graphy and ventriculography without coronary arteries lesions. She was screened for secondary hypertension protocol with a 24 hour urine free catecholamine sample that was clearly elevated. Abdomen computed tomography and magnetic resonance imaging showed a tumor located in the right adrenal gland and she underwent surgical resection.
Conclusions: pheochromocytoma has different clinical presentations that may delay the diagnosis. Early recognition of catecholamine-induced cardiomyopathy and adequate management reduces morbidity and mortality.
References
Sánchez-Turcios A. Feocromocitoma: diagnóstico y tratamiento. Rev Mex Cardiol 2010;21(3):124-137.
Yeo H, Roman S. Pheochromocytoma and functional paraganglioma. Curr Opin Oncol 2005;17(1):13-18.
Thompson NW. Cirugía endocrina. Clin Quir Norteam 1987;2:458-460.
Galetta F, Franzoni F, Bernini G, Poupak F, Carpi A, Cini G, et al. Cardiovascular complications in patients with pheo-chromocytoma: a mini-review. Biomed Pharmacother 2010; 64(7):505-509.
Lairmone TC. Management of pheochromocytoma in patients with MEN. Ann Surg 1993;217(6):595-601.
Kassim TA, Clarke DD, Mai VQ, Clyde PW, Mohamed Shakir KM. Catecholamine-induced cardiomyopathy. Endocr Pract 2008;14(9):1137-1149.
Lyon AL, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (takotsubo) cardiomyopathy-a novel pathophysio-logical hypothesis to explain cathecolamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med 2008; 5(1):22-29.
Mobine H, Baker A, Wang L, Wakimoto H, Jacobsen KC, Seidman CE, et al. Pheochromocytoma-induced cardio-myopathy is modulated by the synergistic effects of cell-secreted factors. Circ Heart Fail 2009;2(2):121-128.
Liao WB, Liu CF, Chiang CW, Kung CT, Lee CW. Cardiovascular manifestations of pheochromocytoma. Am J Emerg Med 2000;18(5):622-625.
Nirgiotis JG, Andrassy RJ. Pheochromocytoma and acute myocardial infarction. South Med J 1990;83(12):1478-1480.
Darzé ES, Von Sohsten RL. Pheochromocytoma-induced segmental myocardial dysfunction mimicking an acute myocardial infarction in a patient with normal coronary arteries. Arq Bras Cardiol 2004;82(2):178-180.
Wafelman AR, Hoefnagel CA, Maessen HJM, Maes RA, Beijnen JH. Renal excretion of Iodine-131 labeled meta-iodobenzylguanidine and metabolites after therapeutic doses in patients suffering from different neural crest-derived tumours. Eur J Nucl Med 1997;24(5):544-552.
Sisson JC, Shulkin BL. Nuclear medicine imaging of pheo-chromocytoma and neuroblastoma. Q J Nucl Med 1999;43 (3):217-223.
van der Hasrt E, de Heder WW, Bruining HA, Bonjer HJ, de Krijger RR, Lamberts SW, et al. [(123)I] metaiodobenzyl-guanidine and [(111)In]octreotide uptake in benign and malignant pheochromocytomas. J Clin Endocrinol Metab 2001;86(2):685-693.
Matsuda T, Murota T, Oguchi N, Kawa G, Muguruma K. Laparoscopic adrenalectomy for pheochromocytoma: a literature review. Biomed Pharmacother 2002;56 (Suppl 1): 132s-138s.