Case Report: Early Resection of Pheochromocytoma in a Patient With Cardiogenic Shock Due to Pheochromocytoma-Induced Cardiomyopathy With Extracorporeal Life Support

Abstract

BackgroundPheochromocytoma-induced cardiomyopathy is a rare but potentially life-threatening complication of pheochromocytoma. It mimics the patterns of stress-induced cardiomyopathy. In severe cases, patients can develop refractory cardiogenic shock, which might require mechanical circulatory support.Case PresentationWe presented a case of 54-year-old female who developed refractory cardiogenic shock, following an elective orthopaedic surgery complicated by cardiac arrest, requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. After urgent coronary catheterisation revealed normal coronary arteries, further evaluation of the aetiology of cardiogenic shock revealed pheochromocytoma. With a diagnosis of pheochromocytoma-induced cardiomyopathy, the patient had accelerated preoperative alpha adrenergic blockade preparation for a total of 6 days and subsequently had the tumour removed under VA-ECMO support. Postoperatively, the patient recovered well and was off ECMO support and extubated a few days later.The optimal management of pheochromocytoma-induced cardiomyopathy, especially for severe cases, is still unclear. Indeed, some cases will require mechanical circulatory support to allow left ventricular function recovery. But our case also showed that it was possible to introduce alpha blockade safely whilst the patient is on VA-ECMO and has the pheochromocytoma removed with VA-ECMO support after accelerated preoperative preparation.

Is Extracorporeal Membrane Oxygenation a Panacea?

“… 64 Veno-arterial ECMO is a suitable treatment option for poisoning cases complicated by refractory cardiogenic shock or cardiac arrest, offering high survival rates with low complications. 65 Extracorporeal membrane oxygenation may be indicated in severe status asthmaticus, 66 pheochromocytoma-induced cardiomyopathy, 67 , 68 fulminant myocarditis, 69 ANCA-associated vasculitis, 70 and refractory thyroid storm. 71 …”

Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review

“…Iatrogenic catecholamine administration was thought to be the cause of TTS-CS in six patients [40,[44][45][46][47]. Nineteen patients developed TTS-CS in the context of pheochromocytoma [48][49][50][51][52][53][54][55][56][57][58][59][60], all of whom received ECLS as MCS, one in combination with IABP and one in combination with Impella. Due to pheochromocytoma, these patients exhibited a markedly higher blood pressure before MCS, with a mean systolic blood pressure of 140.9 mmHg.…”

Орфанні Ендокринні Захворювання: Сучасні Тенденції Хірургічного Лікування В Україні

“…Підготовка до адреналектомії з приводу ФЕО повинна включати стабілізацію артеріального тиску і медикаментозне пом'якшення перебігу кардіоміопатії, спричиненої ФЕО. Проте, оптимальне лікування кардіоміопатії, особливо у важких випадках, досі не встановлено [102].…”