Sinusknotendysfunktion mit intermittierendem Sinusarrest und AV-junktionaler Ersatzrhythmus als Erstmanifestation eines Phäochromozytoms

Abstract

A 25-year-old male student complained about episodic palpitations, dizziness, nausea and headache 5 years prior to presentation. No otorhinolaryngic, neurologic or gastrointestinal causes were identified. Several ECG recordings revealed sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm. The patient was given a permanent DDD-pacemaker. Six months later, the clinical symptoms were unchanged. During an attack, physical examination revealed paleness, diffuse sweating and an arterial blood pressure of 250/130 mmHg, which decreased to 120/80 mmHg within a few minutes. Abdominal ultrasound and abdominal computed tomographic scan demonstrated the presence of a large (6.4 x 5.5 cm) left-sided adrenal mass. Two 24-h-urinary collections demonstrated elevated noradrenaline (mean 315 micrograms/24 h, normal < 80 micrograms/24 h) and adrenaline (mean 268 micrograms/24 h, normal < 20 mg/24 h) levels. Blood samples, which were drawn during excessive blood pressure rise, revealed elevation of plasma catecholamines (6.793 pg/ml for adrenaline (normal 50-150 pg/ml) and 10.424 pg/ml for noradrenaline (normal 200-500 pg/ml), so that the diagnosis of pheochromocytoma was considered established. The tumor was successfully removed during laparascopic surgery. After surgery, the patient remained well and normotensive. Three months later, several long-term ECG recordings showed sinus arrhythmia with no evidence of sinus arrest or AV-nodal escape rhythm, so that the DDD pacemaker was turned off. This case underlines that sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm is a potential early manifestation of a pheochromocytoma. These changes seem to disappear after successful removal of the tumor.

Comparison of Single Culture and the Consortium of Growth-Promoting Rhizobacteria from Three Tomato (Lycopersicon esculentum Mill) Varieties

“…They are due to the secretion of norepinephrine by pheochromocytoma. When betaadrenoceptors are stimulated by excess catecholamine, they can lead to sinus tachycardia, atrial tachyarrhythmia as in our case [5] or even ventricular tachycardias [12], and in rare cases sinus dysfunction [13]. Atrioventricular dissociation was associated with pheochromocytoma in only 2 cases [11].…”

Atrioventricular Dissociation due to Pheochromocytoma in a Young Adult

“…5,6 Unfortunately the diagnosis of pheochromocytomaas cause of sinus arrest, atrioventricular dissociation, or supraventricular arrhythmias is frequently delayed, resulting in pacemaker implantation in some cases (as in ours) and even in His bundle ablation for medication resistant arrhythmias. 11,12 After resection of the tumor the arrhythmias resolved in all cases without further need for pacing. In our patient, the urinary concentrations of catecholamines over a 24 hour period were between 5 and 40 times the upper limit of normal, probably reflecting plasma concentrations between 100 and 1000 times the upper limit of normal.…”

Complete atrioventricular dissociation and sinus arrest after pheochromocytoma resection

“…A number of studies have reported that patients with pheochromocytoma developed bradycardia, including sinus arrest or atrioventricular dissociation, during the preoperative period, 3–8 among whom tumor removal preceded arrhythmia resolution. Excess catecholamine secretion increased vagal discharge through the baroreceptor reflex, and adrenergic receptor desensitization have been considered causes of bradycardia.…”

“…While patients with catecholamine‐secreting tumors usually exhibit tachycardia during the florid phase of their illness, reports have shown that 10% of the patients develop bradycardia 2 . Although a number of studies have shown that some patients with pheochromocytoma present with bradycardia during the preoperative period, 3–8 postoperative bradycardia has remained largely unknown. We present a patient who developed complete atrioventricular dissociation and sinus arrest in the postoperative period after pheochromocytoma resection, which prompted temporary pacemaker implantation.…”