Initial presentation of pheochromocytoma with Takotsubo cardiomyopathy: a brief review of literature

Abstract

Takotsubo cardiomyopathy, or transient left ventricular apical ballooning or broken heart syndrome, is characterized by excessive sympathetic stimulation induced acute coronary vasospasm. A 46-year-old female presented with polyuria and polydypsia and was diagnosed with new-onset diabetes mellitus, treated with insulin and intravenous fluids. During the hospital stay, she complained of an episode of left-sided chest pain and had mildly elevated cardiac enzymes. EKG showed new ST-segment elevation in V2, V3 leads without reciprocal changes. Her coronary angiogram showed no significant coronary artery stenosis, but severe systolic dysfunction and akinesis of the mid-anterior, anteroapical, mid-inferior and inferoapical segments. Further workup was negative except for plasma metanephrine being elevated. MRI of the abdomen showed a right adrenal mass consistent with pheochromocytoma. Surgical resection of the adrenal mass showed evidence of pheochromocytoma and the patient's symptoms were resolved.

Contribution of Catecholamine Reactive Intermediates and Oxidative Stress to the Pathologic Features of Heart Diseases

“…Also, the catecholamine drive can result in microvascular spasms, impaired myocardial fatty acid metabolism, and dynamic mid-cavity obstruction [240]. The exaggerated sympathetic stimulation is probably the key to the cause of this syndrome [240]. Moreover, several 'broken heart syndromes' have been described after the exogenous administration of catecholamines, further corroborating the role of catecholamines in this pathology [40,242,248,249].…”

“…Also, the catecholamine drive can result in microvascular spasms, impaired myocardial fatty acid metabolism, and dynamic mid-cavity obstruction [240]. The exaggerated sympathetic stimulation is probably the key to the cause of this syndrome [240].…”

“…"Takotsubo" cardiomyopathy is mainly typified by transient apical and midventricular a/dyskinesis that extend beyond the distribution of a single coronary artery in the absence of significant coronary artery disease or acute plaque rupture on coronary angiography. It occurs usually after a sudden emotional or physical stress [62,240].…”

Norepinephrine transporter function and human cardiovascular disease

“…Excessive catecholamine concentrations can acutely damage the heart (79) and contribute to myocardial electrical instability, thereby predisposing to cardiac dysrhythmias (122). Indeed, excessive catecholamine release in patients with pheochromocytoma can induce a cardiac myopathy (42). Evidence for excessive adrenergic activity in the heart has been reported in myocardial infarction (1), unstable ischemic heart disease (81), stress-induced cardiomyopathy (71), and congestive heart failure (104).…”

Takotsubo Cardiomyopathy

“…Recurrence of TTC has also been rarely reported with similar or different triggering events (recurrence range, 0 to 8%) (23). TTC has been reported to be associated with pheochromocytoma (24)(25)(26)(27) and subarachnoid hemorrhage (28)(29)(30)(31) (Figure 1) reveals LV dysfunction and wall motion abnormalities affecting apical and, frequently, midventricular myocardium but sparing the basal myocardium, changes which resemble a flask with a narrow neck and a round bottom shaped like the Japanese octopus trap "tako-tsubo" (32). Symptoms can be severe and lead to death in 2% of patients (3).…”