Le phéochromocytome comme cause inhabituelle de choc cardiogénique

Ouchikhe, A.; Lehoux, Philippe; Gringore, A; Renouf, P; Deredec, R.; Tasle, Marine; Massetti, Massimo; Khayat, Anita; Saloux, Éric; Grollier, Gilles; Samama, G; Gérard, Jean Louis

doi:10.1016/j.annfar.2005.08.020

Cited by 8 publications

(3 citation statements)

References 16 publications

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“…Only few cases of pheochromocytomarelated myocarditis have been reported (Tables 1 and 2) [3,[6][7][8][9][10][11][12][13]. This entity is extremely rare so that "real" incidence cannot be accurately determined.…”

Section: Discussion Viral or Catecholamine-induced Fulminant Myocardimentioning

confidence: 99%

Recurrent Fulminant Myocarditis Revealing a Pheochromocytoma

Zghal¹,

Ayari²

2015

J Clin Case Rep

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IntroductionAcute myocarditis is commonly induced by various infections, toxins, drug reactions and autoimmune diseases. Pheochromocytoma is a rare but curable etiology. The diagnosis of pheochromocytoma, called the "great imitator", is definitely one of the most challenging given its wide range of presentations. Making this diagnosis can in fact avoid potentially fatal complications. We report the case of a 61-yearold woman in whom the recurrence of fulminant myocarditis revealed a pheochromocytoma. Case ReportA 61-year-old woman was referred to our center on April 2009 for acute chest pain suggestive of angina. Her previous medical history was significant for type 2 diabetes and systemic hypertension evolving since 2007. She reported flu-like syndrome 15 days before the onset of current symptoms. Electrocardiogram (ECG) at presentation revealed 2 mm ST-segment depression in inferior, apical and lateral leads and premature ventricular beats (Figure 1). Troponin and Creatin-Phospho-Kinase Levels (CPK) were increased and amounted respectively to 23 ng/ml and 495 UI/l. C-reactive protein (CRP) level was inferior to 5 mg/l. Coronary angiography performed at the seventh hour of onset of symptoms showed normal and patent coronary arteries. We did not perform left ventriculography because of high left ventricular end-diastolic pressure (20 mmHg). One hour later, our patient presented rapid deterioration of both hemodynamic and respiratory status justifying her referral to intensive care unit. Cardiogenic shock was confirmed by hemodynamic study performed in the resuscitation department by PiCCO ® monitoring. She received Dobutamine and Furosemide and underwent non-invasive ventilation. Trans-thoracic echocardiography (TTE) performed on the first day (under Dobutamine 10 µg/kg/min) has shown impaired left ventricular systolic function (left ventricular ejection fraction (LVEF)=45%), diffuse hypokinesis, and a moderate functional mitral regurgitation (MR). Clinical course was favorable; Furosemide and Dobutamine were respectively withdrawn on the second and fifth day of hospital stay. Fulminant myocarditis was strongly suspected even if cardiac Abstract Introduction: Pheochromocytoma is a rare etiology of fulminant myocarditis. It is however a curable tumor in which surgical ablation spares patients from dreadful cardiac complications.

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Section: Discussion Viral or Catecholamine-induced Fulminant Myocardimentioning

confidence: 99%

Recurrent Fulminant Myocarditis Revealing a Pheochromocytoma

Zghal¹,

Ayari²

2015

J Clin Case Rep

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“…16,17,20,21,34 –46 A number of publications also depict the use of central cardiopulmonary bypass systems, ventricular assist devices, and IABPs. 19,47 –55…”

Section: Discussionmentioning

confidence: 99%

“…16,17,20,21,[34][35][36][37][38][39][40][41][42][43][44][45][46] A number of publications also depict the use of central cardiopulmonary bypass systems, ventricular assist devices, and IABPs. 19,[47][48][49][50][51][52][53][54][55] Critical care interpretations of serum and urine free catecholamine levels are often confounded by the use of adrenergic agents as well as endogenous (physiological) release. Plasma and urine metanephrines are in this context still considered highly sensitive markers, [56][57][58] although their lack of specificity in this setting demands their combining with clinical presentation and imaging localization of an adrenal mass.…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma-Induced Inverted Takotsubo-Like Cardiomyopathy Leading to Cardiogenic Shock Successfully Treated With Extracorporeal Membrane Oxygenation

Flam

Broomé

Frenckner

et al. 2014

J Intensive Care Med

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Pheochromocytoma classically displays a variety of rather benign symptoms, such as headache, palpitations, and sweating, although severe cardiac manifestations have been described. We report a case of pheochromocytoma-induced inverted takotsubo-like cardiomyopathy leading to shock and cardiac arrest successfully treated with extracorporeal membrane oxygenation (ECMO) as a bridge to pharmacological therapy and curative adrenalectomy. A previously healthy 46-year-old woman presented to the emergency department with abdominal pain, dyspnea, nausea, and vomiting. Clinical evaluation revealed cardiorespiratory failure with hypoxia and severe metabolic acidosis. Computed tomography (CT) scan showed pulmonary edema and a left adrenal mass. Transthoracic echocardiography (TTE) displayed severe left ventricular dysfunction with inverted takotsubo contractile pattern. Despite mechanical ventilation and inotropic and vasopressor support, asystolic cardiac arrest ensued. The patient was resuscitated using manual chest compressions followed by venoarterial ECMO. Repeated TTEs demonstrated resolution of the cardiomyopathy within a few days. Laboratory results indicated transient renal and hepatic dysfunction, and CT scan of the brain displayed occipital infarctions. Biochemical testing and radionuclide scintigraphy confirmed a pheochromocytoma. Pharmacological adrenergic blockade was instituted prior to delayed adrenalectomy after which the diagnosis was histopathologically verified. The patient recovered after rehabilitation. We conclude that pheochromocytoma should be considered in patients presenting with unexplained cardiovascular compromise, especially if they display (inverted) takotsubo contractile pattern. Timely, adequate management might involve ECMO as a bridge to pharmacological therapy and curative surgery.

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