ST-Segment Elevation Myocardial Infarction Related to Potential Spontaneous Coronary Thrombosis in Pheochromocytoma Crisis

Chen, Fei; Zheng, Maojun; Xi, Li; Peng, Yong; Chen, Mao

doi:10.3389/fendo.2020.00140

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…Most of these patients had patent coronary arteries; some of them had "confirmed myocardial infarction" according to the authors [44]. Anterior STEMI due to thrombus occlusion of left anterior descending artery in association with pheochromocytoma has been reported [45]. In 1954, Priest et al reported on the case of a 22-years-old farm-worker, with a "fatal myocardial infarction" [44].…”

Section: Ppgls and Acute Coronary Syndromementioning

confidence: 99%

“…Left ventricular thrombus, coronary thrombosis, and peripheral embolism have been reported in patients with PPGL-induced cardiac complications [13,27,37,50,87]. Chen et al reported on a case of 65-years-old male patient who in association with a PPGL-crisis developed acute anterior STEMI [45]. Coronary angiography confirmed thrombus occlusion of the left anterior descending artery.…”

Section: Ppgls and Thrombo-embolismmentioning

confidence: 99%

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Cardiovascular Manifestations and Complications of Pheochromocytomas and Paragangliomas

Y‐Hassan

Falhammar

2020

JCM

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Pheochromocytomas and paragangliomas (PPGLs) are rare neuro-endocrine tumors. The catecholamine surge causes paroxysmal or chronic secondary hypertension. PPGLs may present as hypertensive- or PPGL-crisis with severe life-threatening cardiac and cerebrovascular complications. PPGLs-induced cardiac manifestations have been reported with diagnoses as PPGLs-induced electrocardiogram (ECG) changes “mimicking acute myocardial infarction”, arrhythmias, myocarditis, acute coronary syndrome, dilated cardiomyopathy, and lately as takotsubo syndrome. Critical analysis of these reports reveals that most of these cardiac manifestations have certain features in common. They have a dramatic clinical presentation and are reversible if the disease is treated with appropriate medical therapy and surgical resection of the PPGL tumor. They may have the same repolarization ECG changes irrespective of the clinical cardiac diagnosis, usually associated with mild to moderate elevations of myocardial biomarkers as troponins and normal coronary arteries. The histopathological findings are usually focal or multifocal in the form hypercontracted sarcomeres and contraction band necrosis (myofibrillar degeneration) with subsequent secondary mononuclear cell infiltration. Evidences argue the PPGL caused surge of catecholamines triggers hyperactivation of the sympathetic nervous system with cardiac sympathetic nerve terminal disruption with norepinephrine spillover causing the cardiac complications. A comprehensive review of various reported cardiovascular manifestations and complications of PPGLs are presented.

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Section: Ppgls and Acute Coronary Syndromementioning

confidence: 99%

Section: Ppgls and Thrombo-embolismmentioning

confidence: 99%

Cardiovascular Manifestations and Complications of Pheochromocytomas and Paragangliomas

Y‐Hassan

Falhammar

2020

JCM

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“…Chen et al . 7 described a case of PHEOs crisis with STEMI. In this case, the risk factors that could predispose to atherosclerosis had shown no indication of coronary plaque formation angiographically.…”

Section: Discussionmentioning

confidence: 99%

Unusual case report of malignant pheochromocytoma presenting with STEMI

Demir

Özbek

Güzel

et al. 2023

European Heart Journal - Case Reports

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Background Pheochromocytomas (PHEOs) are a group of tumours that leads to multiple symptoms and can induce hypercoagulability and promote thrombosis. Pheochromocytomas may also present without elevated serum and urinary markers. We aimed to provide tips and tricks for the diagnostic and therapeutic management of an unusual case of PHEOs. Case summary Thirty-four-year-old woman with the unremarkable medical history presented with epigastric pain and dyspnoea. Electrocardiogram showed ST-segment elevation in the inferior limb leads. She underwent an emergency coronary angiogram, which showed a high thrombus burden in the distal right coronary artery. A subsequent echocardiogram demonstrated a 31 × 33 mm right atrial mass adhering to the inferior vena cava and abdominal computed tomography (CT) scan revealed a 113 × 85 mm necrotic mass in the left adrenal bed, with tumour thrombus extending proximally to the confluence of hepatic veins immediately inferior to the right atrium and distally to iliac vein bifurcation. Blood parameters, thrombophilia panel, vanillylmandelic acid, 5 hydroxy indole acetic acid, and homovanillic acid levels were normal. Tissue sampling confirmed the diagnosis of PHEOs. The surgical procedure was not planned due to the presence of metastatic foci on imaging, including positron emission tomography (PET)–CT. Anticoagulation with rivaroxaban and treatment with 177Lu-DOTATATE-based peptide receptor radionuclide therapy (PRRT) was initiated. Discussion The coexistence of arterial and venous thrombosis is extremely rare in patients with PHEOs. Multidisciplinary approaches are required for the care of such patients. Catecholamines likely contributed to the development of thrombosis in our patient. Early recognition of PHEOs is the key point to ameliorate clinical outcomes.

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“…Another possible explanation for CAD in pheochromocytoma is the hypercoagulability induced by pheochromocytoma leading to thrombosis in the coronary arteries. 8 Here we report an unusual case of typical MEN 2A disease in a 27-year-old female diagnosed with a left anterior descending (LAD) artery disease requiring invasive treatment.…”

Section: Introductionmentioning

confidence: 95%

Left anterior descending artery disease in a 27-year-old with multiple endocrine neoplasia, type 2A: A case report

Al Salihi,

Iyyani,

Koilpillai

et al. 2023

SAGE Open Medical Case Reports

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Multiple endocrine neoplasia 2A is an autosomal dominant disease characterized by medullary thyroid cancer, pheochromocytoma, and primary hyperparathyroidism. Coronary artery disease is associated with the disorder, but the mechanism is unclear. A 27-year-old female presented with chest pain and palpitations. A left heart catheterization was performed and showed 80% stenosis of the left anterior descending artery. Imaging and workup also revealed primary hyperparathyroidism associated with a parathyroid adenoma and elevated serum and urine metanephrines and norepinephrines. A computed tomography of the abdomen revealed a large heterogeneous right adrenal mass measuring 7.9 cm × 6.8 cm × 8 cm consistent with a pheochromocytoma. The patient subsequently underwent adrenal mass resection and a complete thyroidectomy and parathyroidectomy. Early recognition and treatment of multiple endocrine neoplasia 2A can possibly reduce the risk of lethal heart disease in addition to the other associated endocrine disturbances.

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ST-Segment Elevation Myocardial Infarction Related to Potential Spontaneous Coronary Thrombosis in Pheochromocytoma Crisis

Cited by 4 publications

References 12 publications

Cardiovascular Manifestations and Complications of Pheochromocytomas and Paragangliomas

Cardiovascular Manifestations and Complications of Pheochromocytomas and Paragangliomas

Unusual case report of malignant pheochromocytoma presenting with STEMI

Left anterior descending artery disease in a 27-year-old with multiple endocrine neoplasia, type 2A: A case report

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