Risk Factors for Cardiac Complications in Patients With Pheochromocytoma and Paraganglioma: A Retrospective Single-Center Study

Abstract

BackgroundCatecholamine excess arising from pheochromocytomas and paragangliomas (PPGLs) can cause a wide spectrum of cardiac manifestations. Although there are reviews of reported cases, these reviews lack detailed data, which makes it impossible to perform an accurate analysis. In this study, we conducted a comprehensive analysis of cardiovascular complications (CCs), including PPGL-related myocardial injury, cardiogenic shock, and arrhythmias requiring antiarrhythmic therapy, in a large cohort of patients with PPGL.MethodsWe retrospectively analyzed the clinical data of consecutive patients with PPGL admitted between January 2018 and June 2020. The prevalence and the characteristics of patients with CCs were investigated. Moreover, comparisons were made between patients with and without CCs.ResultsCompared with the non-CC group, the percentage of men was significantly lower (14/41 vs.92/175, 34.1% vs. 52.6%, p = 0.034) and the proportion of patients with paroxysmal hypertension was significantly higher (13/41 vs.29/173, 31.7% vs.16.8%, p = 0.03) in the CC group. More patients showed excessive sweating (19/41 vs 64/175, 46.3% vs. 24.0%, p = 0.004) and PPGL crisis (7/41 vs. 10/175, 17.1% vs.5.7%, p=0.035) in the CC group. In terms of laboratory findings, higher white blood cell [7.36 (6.49, 20.23) vs. 5.95 (5.1, 6.97)×109/L, p<0.001] and platelet [339.28 ± 108.54 vs. 250.66 ± 70.83(×109/L), p = 0.021] counts were more common in the CC group. There was also a higher prevalence of combination-producing PPGL in the CC group (13/24 vs.20/149, 54.2% vs.13.4%, p<0.001). However, the tumor size, invasive behavior on histology, and hemorrhage or necrosis on histology did not differ between the two groups. Platelet count [odds ratio (OR): 1.009; 95% confidence interval (CI) 1.001–1.016; p=0.023] and combination-secreting PPGL (OR: 5.009; 95% CI 1.365–18.38; p=0.015) are independent risk factors for CCs in patients with PPGL.ConclusionsIn patients with PPGL, even in the absence of signs and symptoms of CCs, a work up of cardiology should be strongly considered. Importantly, if patients with PPGLs have higher platelet counts and the combination-secreting pattern, they are more likely to have CCs. Thus, a careful cardiac evaluation should be performed.

Cardiovascular Complications in Pheochromocytoma and Paraganglioma: Does Phenotype Matter?

“…The vast majority of published case reports of catecholamine and takotsubolike CMP are associated mainly with an overproduction of adrenaline or both adrenaline and noradrenaline, that is, corresponding to an adrenergic phenotype. 11,13,26 Our work shows that it is predominantly the adrenergic phenotype that shows clinical and laboratory changes with normal coronary angiographic findings categorized as type 2 MI and takotsubo-like CMP. In our cohort, only 2 patients with takotsubo-like CMP showed a noradrenergic phenotype due to the less frequent but possible massive sudden release of noradrenaline.…”

“…Zhao et al 26 found a higher frequency of complications in women with PPGL than in men in a similar group of patients. 26 However, our work shows no sex differences in the incidence of cardiovascular complications in PPGL.…”

“…According to available studies, the incidence of cardiovascular events in PPGL varies between 10.8% and 20.9% in retrospective consecutive cohorts. 13,[25][26][27] However, these studies differed in the criteria of the cardiovascular end point and did not include thromboembolic complications and cerebrovascular events. Zhao et al 26 found a higher frequency of complications in women with PPGL than in men in a similar group of patients.…”

“…13,[25][26][27] However, these studies differed in the criteria of the cardiovascular end point and did not include thromboembolic complications and cerebrovascular events. Zhao et al 26 found a higher frequency of complications in women with PPGL than in men in a similar group of patients. 26 However, our work shows no sex differences in the incidence of cardiovascular complications in PPGL.…”

Effects of Metabolic Syndrome on Cardiovascular Outcomes of Psoriatic Patients with Coronary Artery Disease: A Single Center Retrospective Cohort Study

“…46 Platelet activation and aggregation are critically involved in the pathophysiology of various diseases such as hypertension, diabetes, and cardiac diseases. 47,48 MetS increases the difficulty of managing psoriatic patients with coronary artery diseases, and because of the increased risk of cardiovascular events associated with these conditions, it is vital to detect, prevent, and treat them as early as possible. Dermatologists are often the first to patients, and they need to identify MetS early and manage it.…”