RSS-Feed abonnieren
DOI: 10.1055/s-0032-1306294
High Incidence of Cardiovascular Complications in Pheochromocytoma
Publikationsverlauf
received 31. Oktober 2011
accepted 09. Februar 2012
Publikationsdatum:
19. April 2012 (online)
![](https://www.thieme-connect.de/media/hmr/201205/lookinside/thumbnails/10.1055-s-0032-1306294-1.jpg)
Abstract
Excess of catecholamines in pheochromocytoma is usually accompanied with classical symptoms and signs. In some cases, severe cardiovascular complications (e. g., heart failure, myocardial infarction) may occur. We performed a retrospective analysis focused on the incidence of cardiovascular complications (classified as follows: arrhythmias, myocardial involvement or ischemia and atherosclerosis, cerebrovascular impairment) before the establishment of diagnosis of pheochromocytoma among 145 subjects treated in our hospital. Cardiovascular complications occurred in 28 subjects, but these subjects did not differ significantly from subjects without complications in age, gender, body mass index, paroxysmal symptoms, symptom duration, tumor dimension, catecholamine secretory phenotype, and incidence of hypertension or diabetes mellitus. Arrhythmias occurred in 15 subjects (2 arrhythmia types in 2 subjects): atrial fibrillation in 9 subjects, supraventricular tachycardia in 3 cases, and ventricular tachycardia in 2 patients. Significant bradycardia was noted in 3 cases. Five subjects presented with heart failure with decreased systolic function (takotsubo-like cardiomyopathy found in 2 cases). One subject suffered from hypertrophic obstructive cardiomyopathy. Seven subjects presented with non-ST-segment elevation myocardial infarction, 2 patients with ST-segment myocardial infarction, and 1 subject underwent coronary artery bypass grafting. Two subjects suffered from significant peripheral atherosclerosis. Among cerebrovascular complications, transient ischemic attack was found in 3 cases, 2 subjects suffered from stroke, and subarachnoidal bleeding occurred in 1 patient. One subject suffered from diffuse neurological impairment due to multiple ischemic white matter lesions. These data show relatively high incidence of cardiovascular complications (19.3%) in subjects with pheochromocytoma. Early diagnosis is mandatory to prevent severe complications in pheochromocytoma.
-
References
- 1 Lenders JW, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet 2005; 366: 665-675
- 2 Pacak K, Eisenhofer G, Ahlman H, Bornstein SR, Gimenez-Roqueplo AP, Grossman AB, Kimura N, Mannelli M, McNicol AM, Tischler AS. Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005. Nat Clin Pract Endocrinol Metab 2007; 3: 92-102
- 3 Qin Y, Buddavarapu K, Dahia PL. Pheochromocytomas: from genetic diversity to new paradigms. Horm Metab Res 2009; 41: 664-671
- 4 Jiang S, Dahia PL. Minireview: The Busy Road to Pheochromocytomas and Paragangliomas Has a New Member, TMEM127. Endocrinology 2011; 152: 2133-2140
- 5 Comino-Mendez I, Gracia-Aznarez FJ, Schiavi F, Landa I, Leandro-Garcia LJ, Leton R, Honrado E, Ramos-Medina R, Caronia D, Pita G, Gomez-Grana A, de Cubas AA, Inglada-Perez L, Maliszewska A, Taschin E, Bobisse S, Pica G, Loli P, Hernandez-Lavado R, Diaz JA, Gomez-Morales M, Gonzalez-Neira A, Roncador G, Rodriguez-Antona C, Benitez J, Mannelli M, Opocher G, Robledo M, Cascon A. Exome sequencing identifies MAX mutations as a cause of hereditary pheochromocytoma. Nat Genet 2011; 43: 663-667
- 6 Eisenhofer G, Rivers G, Rosas AL, Quezado Z, Manger WM, Pacak K. Adverse drug reactions in patients with phaeochromocytoma: incidence, prevention and management. Drug Saf 2007; 30: 1031-1062
- 7 Tischler AS. Pheochromocytoma and extra-adrenal paraganglioma: updates. Arch Pathol Lab Med 2008; 132: 1272-1284
- 8 Eisenhofer G, Pacak K, Huynh TT, Qin N, Bratslavsky G, Linehan WM, Mannelli M, Friberg P, Grebe SK, Timmers HJ, Bornstein SR, Lenders JW. Catecholamine metabolomic and secretory phenotypes in phaeochromocytoma. Endocr Relat Cancer 2011; 18: 97-111
- 9 Zelinka T, Eisenhofer G, Pacák K. Pheochromocytoma as a catecholamine producing tumor: Implications for clinical practice. Stress 2007; 10: 195-203
- 10 Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HAJ, Zanchetti A. . 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105-1187
- 11 American Diabetes Association . Diagnosis and classification of diabetes mellitus. Diabetes Care 2011; 34 (Suppl. 01) S62-S69
- 12 Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, Katus HA, Newby LK, Ravkilde J, Chaitman B, Clemmensen PM, Dellborg M, Hod H, Porela P, Underwood R, Bax JJ, Beller GA, Bonow R, Van der Wall EE, Bassand JP, Wijns W, Ferguson TB, Steg PG, Uretsky BF, Williams DO, Armstrong PW, Antman EM, Fox KA, Hamm CW, Ohman EM, Simoons ML, Poole-Wilson PA, Gurfinkel EP, Lopez-Sendon JL, Pais P, Mendis S, Zhu JR, Wallentin LC, Fernandez-Aviles F, Fox KM, Parkhomenko AN, Priori SG, Tendera M, Voipio-Pulkki LM, Vahanian A, Camm AJ, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Widimsky P, Zamorano JL, Morais J, Brener S, Harrington R, Morrow D, Lim M, Martinez-Rios MA, Steinhubl S, Levine GN, Gibler WB, Goff D, Tubaro M, Dudek D, Al-Attar N. Universal definition of myocardial infarction. Circulation 2007; 116: 2634-2653
- 13 Graham JB. Pheochromocytoma and hypertension; an analysis of 207 cases. Int Abstr Surg 1951; 92: 105-121
- 14 McNeil AR, Blok BH, Koelmeyer TD, Burke MP, Hilton JM. Phaeochromocytomas discovered during coronial autopsies in Sydney, Melbourne and Auckland. Aust N Z J Med 2000; 30: 648-652
- 15 Kopetschke R, Slisko M, Kilisli A, Tuschy U, Wallaschofski H, Fassnacht M, Ventz M, Beuschlein F, Reincke M, Reisch N, Quinkler M. Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma. Eur J Endocrinol 2009; 161: 355-361
- 16 Schurmeyer TH, Engeroff B, Dralle H, von zur Muhlen A. Cardiological effects of catecholamine-secreting tumours. Eur J Clin Invest 1997; 27: 189-195
- 17 Eisenhofer G, Timmers HJ, JWM Lenders, Bornstein SR, Tiebel O, Mannelli M, King KS, Vocke CD, Linehan WM, Bratslavsky G, Pacak K. Age at diagnosis of pheochromocytoma differs according to catecholamine phenotype and tumor location. J Clin Endocrinol Metab 2011; 96: 375-384
- 18 Pacak K, Ilias I, Adams KT, Eisenhofer G. Biochemical diagnosis, localization and management of pheochromocytoma: focus on multiple endocrine neoplasia type 2 in relation to other hereditary syndromes and sporadic forms of the tumour. J Intern Med 2005; 257: 60-68
- 19 Guerrero MA, Schreinemakers JM, Vriens MR, Suh I, Hwang J, Shen WT, Gosnell J, Clark OH, Duh QY. Clinical spectrum of pheochromocytoma. J Am Coll Surg 2009; 209: 727-732
- 20 Brouwers FM, Eisenhofer G, Lenders JW, Pacak K. Emergencies caused by pheochromocytoma, neuroblastoma, or ganglioneuroma. Endocrinol Metab Clin North Am 2006; 35: 699-724
- 21 Haine SE, Hp Miljoen, Blankoff I, Vrints CJ. Atrioventricular dissociation due to pheochromocytoma in a young adult. Clin Cardiol 2010; 33: E65-E67
- 22 Methe H, Hinterseer M, Wilbert-Lampen U, Beckmann BM, Steinbeck G, Kaab S. Torsades de Pointes: a rare complication of an extra-adrenal pheochromocytoma. Hypertens Res 2007; 30: 1263-1266
- 23 Stenstrom G, Swedberg K. QRS amplitudes, QTc intervals and ECG abnormalities in pheochromocytoma patients before, during and after treatment. Acta Med Scand 1988; 224: 231-235
- 24 Prejbisz A, Lenders JW, Eisenhofer G, Januszewicz A. Cardiovascular manifestations of phaeochromocytoma. J Hypertens 2011; 29: 2049-2060
- 25 Holaj R, Zelinka T, Wichterle D, Petrák O, Štrauch B, Vránková A, Majtan B, Spáčil J, Malík J, Widimský Jr J. Increased carotid intima-media thickness in patients with pheochromocytoma in comparison to essential hypertension. J Hum Hypertens 2009; 23: 350-358
- 26 Agarwal V, Kant G, Hans N, Messerli FH. Takotsubo-like cardiomyopathy in pheochromocytoma. Int J Cardiol 2011; 153: 241-248
- 27 Grasselli G, Foti G, Patroniti N, Rona R, Perlangeli MV, Pesenti A. Extracorporeal cardiopulmonary support for cardiogenic shock caused by pheochromocytoma: a case report and literature review. Anesthesiology 2008; 108: 959-962
- 28 Brilakis ES, Young Jr WF, Wilson JW, Thompson GB, Munger TM. Reversible catecholamine-induced cardiomyopathy in a heart transplant candidate without persistent or paroxysmal hypertension. J Heart Lung Transplant 1999; 18: 376-380
- 29 Park JH, Kim KS, Sul JY, Shin SK, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW. Prevalence and patterns of left ventricular dysfunction in patients with pheochromocytoma. J Cardiovasc Ultrasound 2011; 19: 76-82
- 30 Agarwal G, Sadacharan D, Kapoor A, Batra A, Dabadghao P, Chand G, Mishra A, Agarwal A, Verma AK, Mishra SK. Cardiovascular dysfunction and catecholamine cardiomyopathy in pheochromocytoma patients and their reversal following surgical cure: Results of a prospective case-control study. Surgery 2011; 150: 1202-1211
- 31 Van Vliet PD, Burchell HB, Titus JL. Focal myocarditis associated with pheochromocytoma. N Eng J Med 1966; 274: 1102-1108
- 32 Lin PC, Hsu JT, Chung CM, Chang ST. Pheochromocytoma underlying hypertension, stroke, and dilated cardiomyopathy. Tex Heart Inst J 2007; 34: 244-246
- 33 Majic T, Aiyagari V. Cerebrovascular manifestations of pheochromocytoma and the implications of a missed diagnosis. Neurocrit Care 2008; 9: 378-381
- 34 Manger WM. The protean manifestations of pheochromocytoma. Horm Metab Res 2009; 41: 658-663