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Recurrent Catecholamine-Induced Cardiomyopathy and Hypertensive Emergencies: A presentation of Pheochromocytoma and
Prince Sethi1, Guy Vin Chang1, Smitha Narayana Gowda1
1Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Insights
Pheochromocytoma, a rare adrenal tumor, can cause recurrent catecholamine-induced cardiomyopathy (CIC) or Takotsubo syndrome (TTS). Early diagnosis is crucial for managing these complex cardiovascular conditions.
Area of Science:
- Cardiology
- Endocrinology
Background:
- Catecholamine-induced cardiomyopathy (CIC) and pheochromocytoma are rare conditions.
- Pheochromocytoma is a potential cause of CIC or Takotsubo syndrome (TTS).
- Diagnosing TTS in patients with pheochromocytoma presents challenges due to rarity and atypical symptoms.
Observation:
- A 51-year-old female experienced three episodes of TTS.
- Her current presentation included hypertensive emergency with symptoms like angina, palpitations, headache, nausea, and vomiting.
- Initial treatment for non-ST elevation myocardial infarction (NSTEMI) was unsuccessful, with coronary angiography showing normal coronary arteries.
Findings:
- Paroxysmal hypertensive emergencies and variable blood pressure responses suggested pheochromocytoma.
- Elevated metanephrines and a 6.3 cm left adrenal mass confirmed the diagnosis.
- This case highlights pheochromocytoma as a primary etiology for recurrent TTS.
Implications:
- Emphasizes the importance of considering pheochromocytoma in recurrent TTS cases.
- Highlights challenges in managing hypertension in patients with both TTS and pheochromocytoma.
- Informs clinical suspicion and diagnostic workup for similar complex presentations.
Abstract:
Catecholamine-induced cardiomyopathy (CIC) and pheochromocytoma are both rare entities, and their exact incidence and prevalence are unknown. Pheochromocytoma has been implicated as one of the causes of CIC or Takotsubo syndrome (TTS) by means of case reports and retrospective reviews. However, the evaluation of any patient with TTS and pheochromocytoma is often faced with multiple challenges due to its rarity and atypical presentations, which subsequently leads to delay in diagnosis. Here, we present a case of a 51-year old female who had three distinct episodes of TTS and now presented in a hypertensive emergency with angina, palpitations, headache, nausea, and vomiting. She was treated for non-ST elevation myocardial infarction (NSTEMI) but coronary angiogram revealed patent coronary arteries. Due to the paroxysmal nature of her hypertensive emergencies and variable blood pressure response, pheochromocytoma was suspected. On further evaluation, she was found to have elevated metanephrines and a 6.3 cm left adrenal mass on CT scan. This case emphasizes the importance of considering or identifying pheochromocytoma as an underlying primary etiology for recurrent episodes of TTS and related concerns such as choice of anti-hypertensive agents.
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