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Cardiovascular manifestations of pheochromocytoma
W B Liao1, C F Liu, C W Chiang
1Department of Internal Medicine, Chang Gung Memorial Hospital-Link, Niaosung, Kaohsiung, Taiwan, ROC.
Insights
Pheochromocytoma, a rare tumor causing varied effects through catecholamine secretion, can mislead emergency physicians. This study highlights its cardiovascular manifestations to improve diagnosis, especially in cases mimicking acute coronary syndrome.
Area of Science:
- Endocrinology
- Cardiology
- Oncology
Background:
- Pheochromocytomas are rare tumors of chromaffin tissue secreting catecholamines.
- These tumors can cause diverse clinical effects, often leading to misdiagnosis by emergency physicians.
- Cardiovascular manifestations are key indicators that can improve diagnostic accuracy.
Purpose of the Study:
- To analyze the clinical cardiovascular manifestations in patients diagnosed with pheochromocytoma.
- To enhance the diagnostic capabilities of emergency physicians when encountering such cases.
- To investigate the association between pheochromocytoma and symptoms mimicking acute coronary syndrome.
Main Methods:
- Retrospective chart review of 25 patients diagnosed with pheochromocytoma at Chang Gung Memorial Hospital (1993-1997).
- Analysis of patient demographics, clinical presentations (adrenergic stimulation), electrocardiographic (ECG) changes, tumor location, and complications.
- Comparison of clinical data with final diagnosis and outcomes.
Main Results:
- Hypertension was the most common major manifestation, with fluctuating blood pressure being a significant clue.
- Six patients exhibited abnormal ECG ST-T segment changes; five presented with chest pain initially suspected as acute coronary syndrome.
- Coronary angiography revealed normal coronary arteries in these five patients, with three having right-sided pheochromocytoma.
Conclusions:
- A high index of suspicion for pheochromocytoma is warranted in patients with chest pain, fluctuating blood pressure, and ischemic ECG changes, even without typical isoenzyme abnormalities.
- Pheochromocytoma should be considered in the differential diagnosis of acute coronary syndrome due to catecholamine-induced symptoms.
- Right-sided pheochromocytomas may present with more pronounced ECG abnormalities and clinical symptoms.
Abstract:
Pheochromocytomas are rare tumors that originate in chromaffin tissue and produce their distant variant effects by secretion of catecholamines, tending to mislead the emergency physicians to a wrong diagnosis. Therefore, we analyze the clinical cardiovascular manifestations in patients with pheochromocytoma to improve the diagnostic ability of the emergency physicians. All patients presenting to the Chang Gung Memorial Hospital between January 1993 and December 1997 with a final diagnosis of pheochromocytoma had their charts reviewed. The data of 25 patients including age, sex, adrenergic stimulation presentations, electrocardiographic changes, location of the tumor, and complications were analyzed. Hypertension was the most important major manifestation and fluctuation of blood pressure drew our attention to the possibility of pheochromocytoma. Six patients had abnormal electrocardiographic ST-T segment changes. Five of them had chest pain which prompted them to undergo coronary angiography before surgery, because acute coronary syndrome (unstable angina and acute myocardial infarction) was suspected initially. However, all of them turned out to have normal coronary arteries. Right-sided pheochromocytoma was found in three of these five patients. We should maintain high index of suspicion for pheochromocytoma in patients presenting with chest pain, fluctuating blood pressure, and ischemic electrocardiogram (ECG) changes despite any typical isoenzyme changes. Pheochromocytoma should also be included in the differential diagnosis of acute coronary syndrome because acute catecholamine secretion may induce chest pain and abnormal ECG changes mimicking an ischemic episode. The right-sided pheochromocytoma may present more striking electrocardiographic abnormalities and clinical manifestations.