Hemorrhagic Pheochromocytoma Associated with Systemic Corticosteroid Therapy and Presenting as Myocardial Infarction with Severe Hypertension

Brown, Hilary; Goldberg, Philip A.; Selter, Jared G.; Cabin, Henry S.; Marieb, Norman J.; Udelsman, Robert; Setaro, John F.

doi:10.1210/jc.2004-1077

Cited by 45 publications

(28 citation statements)

References 81 publications

(41 reference statements)

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“…Including the present case, we identified 14 cases of steroid-induced pheochromocytoma crisis in the English literature between 1969 and 2009 (Table 3) [4][5][6][7][8][9][10][11][12]. There were six men and eight women with the mean age (±SD) of 45.14 ± 13.77 years.…”

Section: Discussionmentioning

confidence: 99%

“…Several classes of drugs may induce a pheochromocytoma crisis in patients with pheochromocytoma. Presentation of pheochromocytoma after administration of steroid is rarely reported [4][5][6][7][8][9][10][11][12]. In this article, we present a case of a pheochromocytoma crisis induced by a steroid in a patient undergoing a high-dose dexamethasone suppression test (DST) for evaluation of a functioning adrenal incidentaloma and review the literature on steroid-induced pheochromocytoma crisis.…”

Section: Introductionmentioning

confidence: 99%

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Pheochromocytoma crisis after a dexamethasone suppression test for adrenal incidentaloma

Kim

Shin

et al. 2010

Endocr

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A 61-year-old woman was referred to our department for evaluation of an incidental adrenal mass. An abdominal CT scan revealed a 4.1 cm right adrenal mass. The patient had been diagnosed with hypertension 7 years earlier and had taken antihypertensive medications intermittently. Her physical examination demonstrated a round face, central obesity, and mild hypertension. Serum catecholamines, renin, aldosterone, ACTH and 24-h urine-free cortisol, vanillylmandelic acid levels were within normal limits. However, serum cortisol level was markedly elevated and the circadian rhythm was disturbed. Successive low-dose and high-dose dexamethasone suppression tests were ordered for evaluation of a functioning adrenal incidentaloma. About 2 h after taking the second dose of 2 mg dexamethasone, she suddenly developed nausea and vomiting, palpitations, and anxiety with severe hypertension. On the same day, we measured serum catecholamines, which were markedly elevated. An elective laparoscopic right adrenalectomy was performed and pathologic examination confirmed the diagnosis of pheochromocytoma. One week after surgery, serum and urine catecholamine levels returned to normal. The patient has remained normotensive without any medications and clinically well. Patients with adrenal incidentalomas may have a functional mass that does not always manifest as a full symptomatic disease. During the investigation of adrenal incidentalomas, pheochromocytoma should ideally be ruled out before administering corticosteroids.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pheochromocytoma crisis after a dexamethasone suppression test for adrenal incidentaloma

Kim

Shin

et al. 2010

Endocr

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“…Haemorrage into the tumour can precipitate catecholamine crisis and myocardial infarction. 9 In our case also, hemorrhage into the mass might have precipitated the catecholamine surge accounting for the myocardial infarction.…”

Section: Discussionmentioning

confidence: 54%

Pheochromocytoma Presenting As Acute Myocardial Infarction

Narayanapillai

Shanmugavel

2015

Nepalese Heart J.

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Pheochromocytomas are rare neuro-endocrine tumors arising from chromaffin cells of the sympathetic nervous system.Pheochromocytomacan have diverse clinical presentations, which makes the diagnosis often difficult. We present a case of adrenalpheochromocytoma presenting as acute ST elevation myocardial infarction (STEMI). Catecholamine surge in patients with pheochromocytoma can cause myocardial infarction in the absence of atherosclerotic coronary artery disease. Pheochromocytoma presenting as acute myocardial infarction is very rare and it occurs in young individuals. This is a rare case report of pheochromocytoma in an elderly male presenting with acute STEMI successfully treated by resection of tumor.Key words: pheochromocytoma, myocardial infarction, catecholamines, hypertension Case ReportA 62 year old farmer presented with severe epigastric discomfort, vomiting and profuse sweating. He was hypertensive and diabetic since last four years poorly compliant on treatment. His blood pressure was 190/110 mmHg and heart rate was 60 beats per minute. Precordial examination was unremarkable except for a loud fourth heart sound. Initial ECG showed tall peaked T waves in precordial leads suggesting hyperacute changes of myocardial infarction. Subsequent ECGs showed loss of R waves with coved ST elevation and T wave inversion in leads V2,V3 and V4. Leads I,II,III,aVF, V5 and V6 showed T wave inversions (Fig 1). His echocardiogram showed severe hypokinesia of apical interventricular septum and apex with normal left ventricular systolic function.He was subjected to an immediate coronary angiogram with intention for primary percutaneous revascularization. Surprisingly his diagnostic coronary angiogram showed normal epicardial coronary arteries and no evidence of atherosclerosis (Fig 2).So he was treated conservatively with antiplatelet agents, nitroglycerine and statins.In his subsequent ECG sprecordial ST segment returned to baseline with deep T wave inversions, typical of serial evolutionary changes of STEMI. Cardiac enzymes were elevated, serum troponin I of 9ng/ml, (normal cut off is less than 0.05ng/ml).During the hospital stay he developed recurrent episodes of similar but less intense episodes of abdominal discomfort and vomiting. His blood pressure increased to levels as high as 200/120 mm of Hg during the episodes along with sinus tachycardia. This prompted us to suspect an alternative diagnosis in this case. His thyroid function tests were normal. In view of the labile hypertensive changes, we also considered the possibility of pheochromocytoma and proceed with an ultra sonogram of the abdomen which showed a mass in the region of right suprarenal gland. 24 hr urine metanephrine levels were elevated (14.5 mg, normal value < 1 mg/24 hrs). A contrast enhanced CT scan of abdomen showed right suprarenal mass which was a well encapsulated with a fluid level (Fig 3). Both kidneys and left suprarenal gland were normal. Thus we arrived at a diagnosis of pheochromocytoma and the acute myocardial infarction was pr...

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“…When the process of necrosis comprises some of the tumor area, there is also damage of the small vessels, which results in blood effusions [8]. Some authors reported other possible reasons which lead to blood effusions, such as: minor traumas of the lumbar region or chronic steroid therapy [9,10]. Consequences of the intratumoral haemorrhages are connected both with its diameter and dynamics.…”

Section: Discussionmentioning

confidence: 99%