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Published on: September 15, 2017
Cardiac abnormalities associated with pheochromocytoma and other adrenal tumors
Run Yu1, Lena Furmark, Christopher Wong
1Division of Endocrinology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. run.yu@cshs.org
Insights
Pheochromocytoma can cause specific cardiac issues, including prolonged QTc intervals and ST-T abnormalities on electrocardiograms. Evaluating cardiac function with ECG and echocardiography is recommended for these patients.
Area of Science:
- Cardiology
- Endocrinology
- Oncology
Background:
- Pheochromocytoma, a rare tumor of the adrenal gland, can cause significant cardiovascular complications due to excess catecholamine secretion.
- Understanding these cardiac manifestations is crucial for timely diagnosis and management.
Purpose of the Study:
- To investigate the specific cardiac abnormalities associated with pheochromocytoma.
- To propose a strategy for assessing cardiac function in patients diagnosed with pheochromocytoma.
Main Methods:
- A case-control study was conducted, comparing 22 patients with pheochromocytoma to 35 patients with nonfunctioning adrenal tumors.
- Data reviewed included clinical history, imaging, pathology, biochemical results, electrocardiography (ECG), and echocardiography.
Main Results:
- Patients with pheochromocytoma showed a significantly prolonged QTc interval (P = .02) compared to controls, correlated with norepinephrine and normetanephrine levels.
- ST-T abnormalities were more frequent in the pheochromocytoma group (50% vs 23%, P = .04).
- Myocardial damage was observed in 9% of pheochromocytoma patients, and abnormal left ventricular wall motion was noted in those with prolonged QTc.
Conclusions:
- Prolonged QTc and ST-T abnormalities are specific electrocardiographic findings in pheochromocytoma.
- Routine ECG is advisable for pheochromocytoma patients.
- Echocardiography is recommended for evaluating left ventricular wall motion in patients with prolonged QTc, and coronary artery disease should be considered for significant ST-T changes.
Objective:
To study the specific cardiac abnormalities associated with pheochromocytoma and to suggest a strategy for evaluating cardiac function in patients with pheochromocytoma.
Methods:
In this case-control study, we reviewed pathology records of patients seen at Cedars-Sinai Medical Center between 1997 and 2007; patients with adrenal or extra-adrenal pheochromocytoma and those with nonfunctioning benign or malignant adrenal tumors were identified. Patients with functioning adrenal adenomas that secreted cortisol or aldosterone were excluded. Clinical history, imaging, pathology, biochemical test results, electrocardiographic findings, and echocardiographic findings were compared between patients with pheochromocytoma and patients with nonfunctioning adrenal tumors.
Results:
The charts of 22 patients with pheochromocytoma and 35 patients with nonfunctioning adrenal tumors were included. No perioperative mortality was observed. The average age of patients with pheochromocytoma was similar to that of control patients (51.9 +/- 3.9 years vs 60.2 +/- 2.5 years, respectively), as was the number of patients with known cardiovascular diseases (2 [9%] in the pheochromocytoma group vs 5 [14%] in the control group). Two patients with pheochromocytoma (9%) exhibited myocardial damage. Abnormal electrocardiographic findings were present in 16 patients with pheochromocytoma (73%) and in 17 control patients (49%) (P = .1). QTc was prolonged in patients with pheochromocytoma compared with control patients (448.3 +/- 9.7 ms vs 424.7 +/- 4.5 ms, respectively; P = .02) and was correlated with levels of norepinephrine and normetanephrine, but not with levels of epinephrine and metanephrine or tumor size. ST-T abnormalities were present in 11 patients with pheochromocytoma (50%) and in 8 control patients (23%) (P = .04). Echocardiographic findings were normal in most patients with pheochromocytoma; abnormal left ventricular wall motion was documented in 3 patients with long QTc.
Conclusions:
The specific electrocardiographic findings in patients with pheochromocytoma are prolonged QTc and ST-T abnormalities. Performing an electrocardiogram in patients with pheochromocytoma would be prudent. Echocardiography would be useful to examine LV wall motion in patients with long QTc. Coronary artery disease should be excluded in patients with significant ST-T changes.
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