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Cardiomyopathies and Adrenal Diseases

Luigi Petramala1, Antonio Concistrè1, Federica Olmati1

  • 1Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy.

International Journal of Molecular Sciences
|July 26, 2020
PubMed

Insights

Endomyocardial biopsy (EMB) is a safe and valuable tool for diagnosing cardiomyopathies caused by adrenal diseases like primary aldosteronism, Cushing's syndrome, and pheochromocytoma. EMB reveals specific microscopic changes, aiding in understanding and managing these complex heart conditions.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pathology

Background:

  • Cardiomyopathies involve structural/functional heart muscle abnormalities.
  • Adrenal diseases (hyperaldosteronism, hypercortisolism, hypercatecholaminism) were previously misunderstood causes of cardiomyocyte disorders.
  • Endomyocardial biopsy (EMB) was historically deemed too invasive, hindering diagnosis.

Purpose of the Study:

  • To review the role of EMB in diagnosing cardiomyopathies associated with adrenal diseases.
  • To highlight key microscopic and ultrastructural findings from recent EMB studies.
  • To emphasize EMB as a safe and informative diagnostic tool.

Main Methods:

  • Review of recent endomyocardial biopsy (EMB) studies.
  • Analysis of histopathological and ultrastructural features in patients with adrenal diseases and cardiomyopathies.
  • Focus on primary aldosteronism (PA), Cushing's syndrome (CS), and pheochromocytoma (PHEO).

Main Results:

  • Primary aldosteronism (PA): Aldosterone excess causes ion/water imbalance, vacuolization, swelling, and potential interstitial edema.
  • Cushing's syndrome (CS): Characterized by cardiomyocyte hypertrophy and myofibrillolysis, linked to increased atrogin-1 expression.
  • Pheochromocytoma (PHEO): Shows myofilament hypercontraction, contraction bands, and occasional necrosis.

Conclusions:

  • Endomyocardial biopsy (EMB) is a safe and effective technique when performed in experienced centers.
  • EMB provides crucial insights into the physiopathological mechanisms of cardiomyopathies linked to adrenal disorders.
  • EMB can guide new management strategies and therapies for these conditions.

Keywords:
Cushing’s syndromeadrenal diseasecardiomyopathyendomyocardial biopsypheochromocytomaprimary aldosteronism

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