Emergency adrenalectomy due to acute heart failure secondary to complicated pheochromocytoma: a case report

Salinas, Carlos León; Beltrán, Óscar Dario Gómez; Sánchez-Hidalgo, Juan Manuel; Bru, Rubén Ciria; Padillo, Francisco J.; Rufián, Sebastián

doi:10.1186/1477-7819-9-49

Cited by 21 publications

(13 citation statements)

References 21 publications

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“…In a number of cases, IABP has been used to excellent effect . If IABP provides insufficient mechanical circulatory support, then extra‐corporeal life support (VA‐ECMO), through either femoral or central access, or cardiopulmonary bypass has been used successfully .…”

Section: Managementmentioning

confidence: 99%

Phaeochromocytoma crisis

Whitelaw

Prague

Mustafa

et al. 2013

Clinical Endocrinology

166

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SummaryPhaeochromocytoma crisis is an endocrine emergency associated with significant mortality. There is little published guidance on the management of phaeochromocytoma crisis. This clinical practice update summarizes the relevant published literature, including a detailed review of cases published in the past 5 years, and a proposed classification system. We review the recommended management of phaeochromocytoma crisis including the use of alpha-blockade, which is strongly associated with survival of a crisis. Mechanical circulatory supportive therapy (including intra-aortic balloon pump or extra-corporeal membrane oxygenation) is strongly recommended for patients with sustained hypotension. Surgical intervention should be deferred until medical stabilization is achieved.

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Section: Managementmentioning

confidence: 99%

Phaeochromocytoma crisis

Whitelaw

Prague

Mustafa

et al. 2013

Clinical Endocrinology

166

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“…Previous case reports demonstrated that the cardiomyopathy can be reversed with surgical removal of pheochromocytoma 6 17. Our patient's ejection fraction increased from 10% on presentation to 55% prior to surgery after approximately 10 days of α and β blockade.…”

Section: Discussionmentioning

confidence: 50%

“…Paroxysmal symptoms usually last minutes to less than an hour; however, two documented episodes in our patient lasted greater than 4 h (see figure 1). Rarely, failure to diagnose and treat this condition can lead to congestive heart failure 5 6. The cause of the heart failure is unclear; however, catecholamine-induced cardiomyopathy or the abrupt withdrawal of catecholamine signalling in a patient with desensitised adrenoreceptors and a reduced circulatory volume may play a role.…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma presenting as acute decompensated heart failure reversed with medical therapy

Mulla

Marik²

2012

BMJ Case Reports

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A 26-year-old woman presented to hospital with acute chest pain, hypertension, tachycardia and an elevated serum creatinine. She developed respiratory distress requiring endotracheal intubation and mechanical ventilation. She progressed to multiorgan failure due to decompensated congestive heart failure. Echocardiography demonstrated global hypokinesis and an ejection fraction of <10%. Her cardiac function improved with fluid resuscitation and β blockade, and she was eventually discharged home. She was readmitted a few days later with pancreatitis after presenting with nausea, abdominal pain and hypertension. During hospitalisation she had paroxysms of headache, nausea and diaphoresis associated with hypertension and tachycardia. A CT scan of her abdomen revealed an adrenal mass and serum metanephrine studies confirmed the diagnosis of pheochromocytoma. After fluid resuscitation and sympathetic blockade her ejection fraction improved to 55%. The patient underwent an uneventful adrenalectomy and made a complete recovery.

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“…The treating physicians, however, elected to proceed with emergent adrenalectomy. The patient's haemodynamic and respiratory status greatly improved shortly after surgery [15].…”

Section: Initial Management: When Is It Appropriate To Operate?mentioning

confidence: 97%

Pheochromocytoma Crisis

Castelino¹,

Mitmaker²

2017

Clinical Management of Adrenal Tumors

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Pheochromocytomas are rare tumours of the adrenal gland that secrete catecholamines. The classical presentation of these tumours consists of a clinical triad of headaches, palpitations and diaphoresis. This clinical presentation should not be confused with the potentially fatal presentation of pheochromocytoma crisis, which may include severe haemodynamic instability and collapse, multi-organ failure, hyperthermia and encephalopathy. When patients present in profound shock, supportive care and treatment are initiated. Patients presenting with pheochromocytoma crisis have an underlying adrenal tumour, but the clinical manifestations of this life-threatening condition can mimic other entities. Once diagnosis is made, previous anecdotal evidence has shown that pheochromocytoma crisis is a surgical emergency. However, retrospective study of a larger sample of patients presenting with pheochromocytoma crisis suggests that medical management in the acute setting is appropriate and safe. The ultimate treatment is indeed surgical; however, there is no clear recommendation for the acute management of pheochromocytoma crisis. This chapter will focus on the medical and surgical management of potentially life-threatening pheochromocytoma crisis. An in-depth review of the clinical presentation, pathophysiology, causes and treatments of pheochromocytoma crisis will be provided, including the controversial areas surrounding decision-making and timing for adrenalectomy.

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Emergency adrenalectomy due to acute heart failure secondary to complicated pheochromocytoma: a case report

Cited by 21 publications

References 21 publications

Phaeochromocytoma crisis

Phaeochromocytoma crisis

Pheochromocytoma presenting as acute decompensated heart failure reversed with medical therapy

Pheochromocytoma Crisis

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