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[Cardiac involvement in pheochromocytoma. A report of 6 cases]
1Servizio Speciale di Microcircolazione, Università degli Studi di Roma, La Sapienza.
Insights
Pheochromocytoma, a rare tumor, frequently causes heart problems due to excess adrenergic hormones. Surgical removal is the only effective treatment for these catecholamine-induced myocardial effects.
Area of Science:
- Cardiology
- Endocrinology
- Oncology
Background:
- Pheochromocytoma is a rare neuroendocrine tumor causing hypertension.
- Excess catecholamine release from pheochromocytoma can lead to significant cardiovascular complications.
- Myocardial involvement is a frequently reported, yet often under-recognized, manifestation of pheochromocytoma.
Observation:
- This study reports on 6 patients with pheochromocytoma who exhibited significant cardiac alterations.
- Clinical and instrumental evaluations revealed diverse cardiac manifestations.
- Electrocardiographic abnormalities were present in 5 out of 6 patients, including myocardial infarction, left ventricular hypertrophy, and conduction blocks.
Findings:
- The observed cardiac issues included inferior myocardial infarction, left ventricular hypertrophy, negative T waves, ventricular extrasystoles, and complete atrioventricular block.
- Echocardiography in one patient showed left ventricular hypertrophy, particularly affecting the interventricular septum.
- These cardiac symptoms sometimes represent the sole presentation of the underlying pheochromocytoma.
Implications:
- The findings underscore the critical importance of considering pheochromocytoma in patients presenting with unexplained cardiac abnormalities, especially hypertension.
- Early diagnosis and intervention are crucial to prevent severe, potentially life-threatening cardiovascular complications.
- Surgical resection of the pheochromocytoma is currently the definitive treatment to reverse and eliminate the adverse myocardial effects of excess catecholamines.
Abstract:
Pheochromocytoma is a rare case of sustained hypertension or hypertensive crisis: sometimes it may occur with several aspecific symptoms or hypotension. The literature reports frequent myocardial involvement in patients affected by pheochromocytoma. Adrenergic hormone effects are responsible for a functional coronary insufficiency which causes myocardial damage. The cardiac involvement may appear with symptoms of different severity that sometimes represent the only symptoms of the neoplasia. Clinical and instrumental cardiac alterations observed in 6 patients suffering from pheochromocytoma are reported. Electrocardiographic abnormalities were found in 5 out of 6 patients. Inferior myocardial infarct was present in one case; in two patients electrocardiogram showed left ventricular hypertrophy and negative T wave; frequent ventricular extrasystoles in one case and complete atrio-ventricular block in another were found during the hypertensive crisis; in one patient the electrocardiogram showed STT changes and in the last one, left ventricular hypertrophy, more evident in the interventricular septum, was present at the echocardiogram. All subjects underwent surgical treatment after a period of drug therapy. To date surgery is the only possibility to eliminate myocardial malignant effects of catecholamines.