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A Convenient Method for Extraction and Analysis with High-Pressure Liquid Chromatography of Catecholamine Neurotransmitters and Their Metabolites

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[Catecholamine Cardiomyopathy Presenting Inverted-takotsubo Pattern Asynergy].

Takuya Okuno, Miki Hino, Ryosuke Kiyama

Masui. the Japanese Journal of Anesthesiology

|November 2, 2018

Summary

Pheochromocytoma crisis complicated by catecholamine cardiomyopathy requires careful anesthetic management. Preoperative continuous hemodiafiltration can aid in controlling severe hypertension and tachycardia before surgery.

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Area of Science:

Anesthesiology
Cardiology
Endocrinology

Background:

Pheochromocytoma crisis can lead to catecholamine cardiomyopathy, complicating surgical management.
Inverted-takotsubo pattern asynergy is a rare presentation of catecholamine cardiomyopathy.

Observation:

A 48-year-old male presented with pheochromocytoma crisis and inverted-takotsubo cardiomyopathy.
Preoperative management included alpha and beta blockers, intubation for pulmonary edema, and continuous hemodiafiltration (CHDF).

Findings:

Laparoscopic adrenalectomy was performed under total intravenous anesthesia.
Intraoperative hypertension was managed with landiolol, phentolamine, and nitroglycerin infusions.
Post-operatively, vasopressors (noradrenaline and dopamine) were initiated in the ICU.

Implications:

This case highlights successful anesthetic strategies for pheochromocytoma with complex cardiomyopathy.
Preoperative CHDF is a valuable adjunct for managing refractory hypertension and tachycardia in such cases.
Supportive care remains crucial for inverted-takotsubo pattern asynergy.