Differences in Left Ventricular Structural and Functional Changes Between Pheochromocytoma and Essential Hypertension: Role of Elevated Circulating Catecholamines

Abstract

Experimental findings suggest that catecholamines increase protein synthesis and play a role in cardiac hypertrophy. We hypothesize that elevated circulating plasma catecholamines in pheochromocytoma influence cardiac structural and functional remodeling. We compared 15 patients with surgically proven pheochromocytoma and 15 with untreated essential hypertension; we matched the patients for age, sex, body surface area, and blood pressure (BP) levels. Left ventricular hypertrophy (LVH) was identified by M-mode echocardiography in six patients with pheochromocytoma and in four with essential hypertension. Among both groups there were no differences in cardiac structure, no correlation between left ventricular mass and BP, no significant differences in mitral E-F slope, no correlation between either plasma norepinephrine or plasma epinephrine levels, and no differences in the left ventricular structural indices measured. In the pheochromocytoma group, left ventricular end systolic stress and end systolic diameter were significantly lower and left ventricular percent fractional shortening was higher. Plasma norepinephrine levels were higher in the pheochromocytoma group, but did not differ among patients of that group with and without LVH. We conclude that in both pheochromocytoma and essential hypertension, only a subset of patients develop evidence of LVH, and that in pheochromocytoma, the elevation of circulating plasma catecholamines is not necessarily associated with LVH. These results indicate that factors other than catecholamines and BP determine the development of LVH in pheochromocytoma.

Humoral Determinants of the Left Ventricular Function in Pheochromocytoma Patients

“…An abnormally high ESS in some cases of pheochromocytoma may result from cat echolamine-related blood pressure rise. On the other hand, studies from many laboratories found that in essenDiscussion Pheochromocytoma is a rare disease and reports on its influence on the heart are scarce [1,4]. Our findings are similar to those reported by Shub et al [4], In their study LV hypertrophy was found in 20% of the patients, and mean values of indices of systolic function like EF or FS remained normal; some abnormally high and sporadically low values were observed [4].…”

“…Alpha-adrenergic stimulation leads to hyper tension and left ventricular (LV) hypertrophy (LVH). Beta-adrenergic stimulation induces symptoms and signs of so-called 'hyperkinetic heart syndrome' [1]. Beta recep tor down regulation possibly modifies these symptoms.…”

Hypertension and the heart

“…The prevalence of LV hypertrophy in secondary forms of hypertension due to renovascular or endocrinological disease is similar to that in essential hypertension. 18,19 Racial differences have also been observed. In elderly hypertensive patients LV hypertrophy was more common in black (73%) than in Hispanic hypertensive subjects (53%), with white individuals in the intermediate range (60%).…”

The value of plasma markers for the clinical behaviour of phaeochromocytomas

“…Some authors have suggested that CATs exert a direct effect on myocardial growth (42). Others were, however, unable to show correlations between NE and EPI plasma levels and the presence of left ventricular hypertrophy (43).…”