Crise de feocromocitoma simulando um infarto agudo do miocárdio em paciente com artérias coronárias normais

Abstract

We report a case of pheochromocytoma-induced segmental myocardial dysfunction and electrocardiographic abnormalities mimicking an acute anterior myocardial infarction, probably due to coronary spasm. Coronary angiography showed normal coronaries, and the electrocardiographic and echocardiographic changes resolved completely after therapy with an alpha-adrenergic blocker and tumor removal. Our case illustrates the importance of maintaining a high index of suspicion in patients presenting with an unexpected myocardial event and a hypertensive crisis.Pheochromocytoma is a catecholamine-secreting tumor that arises from chromaffin tissue of the sympathetic nervous system. The usual manifestations of this tumor include palpitations, diaphoresis, headache, and paroxysmal hypertension. In addition to the classic symptoms, pheochromocytomas have been rarely associated with acute myocardial infarction and other cardiovascular complications 1 . We report the case of a patient with an adrenal pheochromocytoma and normal coronary arteries who presented with electrocardiographic and echocardiographic findings consistent with an acute anterolateral myocardial infarction (MI), with complete reversal of these abnormalities after alpha-adrenergic treatment. Case ReportA 46-year-old female with history of hypertension was hospitalized with nausea, vomiting, and diaphoresis for 2 days. On physical examination, her initial blood pressure was 230/130 mmHg; heart rate, 132 bpm; and her skin was mottled. The rest of the examination was unremarkable. The electrocardiogram ( fig. 1) showed sinus tachycardia with ST segment elevation and deep, symmetric T wave inversion in leads V2 thru V6. The T waves were also inverted in leads I, aVL, II, and aVF. The QT interval was markedly prolonged and Q waves were present in leads II, III, aVF.She was taken to the cardiac catheterization laboratory where a coronary angiogram showed no significant coronary disease. The left ventriculogram ( fig. 2) showed severe anterolateral and apical hypokinesis. During the procedure, the patient required mechanical ventilation, and the arterial blood pressure became very labile, going from as high as 320/240 mmHg to as low as 70/30 mmHg, warranting the use of vasodilators and, at times, vasopressors. The diagnosis of pheochromocytoma was suspected, and therapy with an alpha-adrenergic blocker was started, which slowly controlled the blood pressure.Laboratory data included 24-hour urinary vanillylmandelic acid, metanephrine, epinephrine, and norepinephrine levels that were, respectively, 313 mg (normal, 2-10), 76 (normal, 0.3-0.9), 12339 ng (normal, 0-16), and 28316 ng (normal, 11-86). The blood urea nitrogen was 26 mg/dL and creatinine was 2.0 mg/dL. The peak CPK level was 951 IU/L with a normal MB fraction. A computed tomography revealed a rounded mass in the left adrenal gland.Blood pressure returned to normal within 5 days of therapy with an intravenous alpha-adrenergic blocker. The patient was extubated, and renal function normalized. Serial echocardiogram...

Feocromocitoma assintomático em uma paciente jovem com incidentaloma adrenal

“…devendo ser considerado sempre em pacientes com hipertensão arterial intermitente e resistente ao tratamento anti-hipertensivo convencional (Faiçal e Shiota, 1997;Vinícius e Malachias, 2002). Além da hipertensão, comumente paroxística, portadores do tumor tem como manifestações clínicas palpitações, sudorese e cefaléia, resultantes da hiperestimulação simpática (Darzé, Sohsten e Atlantis, 2004). Entretanto, em casos mais raros, os pacientes com feocromocitoma podem ser assintomáticos, sendo diagnosticados acidentalmente após realização de exames de imagens por outras razões (Bovio et al, 2006).…”