Advertisement

Pheochromocytoma-Induced Tako-Tsubo Syndrome: An Uncommon Presentation

      Abstract

      Background

      A pheochromocytoma-induced tako-tsubo syndrome is a life-threatening complication of the rare endocrinological disease. The association between the two syndromes is known, though seldom reported in literature, but the categorization is still debated.

      Case Report

      In this article, we provide two examples of clinical presentation of this rare condition, its diagnosis using point-of-care ultrasound, its management in the emergency department, and finally, a literature review.

      Why Should an Emergency Physician Be Aware of This?

      In case of a tako-tsubo syndrome-like myocardial dysfunction in a patient with unknown medical history, or recorded hypertensive or tachycardic peaks, a point-of-care ultrasound scan extended to the kidneys could help evaluate for a reversible underlying trigger cause such as pheochromocytoma.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Leung K
        • Stamm M
        • Raja A
        • Low G.
        Pheochromocytoma: the range of appearances on ultrasound, CT, MRI, and functional imaging.
        AJR Am J Roentgenol. 2013; 200: 370-378
        • Ghalandarpoor-Attar SN
        • Ghalandarpoor-Attar SM
        • Borna S
        • Ghotbizadeh F.
        A rare presentation of pheochromocytoma in pregnancy: case report.
        J Med Case Rep. 2018; 12: 37
        • Novo S
        • Akashi Y
        • Arbustini E
        • et al.
        Takotsubo cardiomyopathy: a consensus document.
        G Ital Cardiol (Rome). 2008; 9 ([in Italian]): 785-797
        • Kawai S
        • Kitabatake A
        • Tomoike H
        • Takotsubo Cardiomyopathy Group
        Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy.
        Circ J. 2007; 71: 990-992
        • Ghadri JR
        • Wittstein IS
        • Prasad A
        • et al.
        International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology.
        Eur Heart J. 2018; 39: 2032-2046
        • Ghadri JR
        • Wittstein IS
        • Prasad A
        • et al.
        International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management.
        Eur Heart J. 2018; 39: 2047-2062
        • Copetti R
        • Peric D
        • Amore G
        • Guglielmo N
        • Federici N
        • Cominotto F.
        Transient Tako-Tsubo cardiomyopathy after cardiopulmonary resuscitation: a causal role of adrenaline?.
        Resuscitation. 2013; 84: e45-e46
        • Polito MV
        • Ravera A
        • Silverio A
        • et al.
        A peculiar etiology of acute heart failure: adrenergic myocarditis.
        Am J Emerg Med. 2015; 33 (e3–6): 1545
        • Cha KC
        • Kim HI
        • Kim OH
        • et al.
        Echocardiographic patterns of postresuscitation myocardial dysfunction.
        Resuscitation. 2018; 124: 90-95
        • Kurisu S.
        Left-ventricular apical ballooning and cardiac arrest: cause or consequence?.
        J Cardiovasc Med. 2011; 12: 28
        • Michels G
        • Pfister R.
        Postresuscitation myocardial dysfunction or a variant of takotsubo cardiomyopathy?.
        Resuscitation. 2018; 128: e3
        • Madias JE.
        Takotsubo-like state after AMI complicated by VF or cardiac arrest: misleading role of first echocardiogram.
        J Am Coll Cardiol. 2016; 68: 326-327
        • Zhang R
        • Gupta D
        • Albert SG.
        Pheochromocytoma as a reversible cause of cardiomyopathy: analysis and review of the literature.
        Int J Cardiol. 2017; 249: 319-323
        • Hassan SY.
        Clinical features and outcome of pheochromocytoma-induced takotsubo syndrome: analysis of 80 published cases.
        Am J Cardiol. 2016; 117: 1836-1844
        • Di Palma G
        • Daniele GP
        • Antonini-Canterin F
        • Piazza R
        • Nicolosi GL.
        Cardiogenic shock with basal transient left ventricular ballooning (Takotsubo-like cardiomyopathy) as first presentation of pheochromocytoma.
        J Cardiovasc Med. 2010; 11: 507-510
        • Tafreshi S
        • Naqvi SY
        • Thomas S.
        Extra-adrenal pheochromocytoma presenting as inverse takotsubo-pattern cardiomyopathy treated with surgical resection.
        BMJ Case Rep. 2018; 11e226384
        • Vilcant V.
        Pheochromocytoma-induced cardiomyopathy mimicking acute coronary syndrome.
        J Am Osteopath Assoc. 2017; 117: 537-540
        • Hayiroǧlu MI
        • Yildirimtürk Ö
        • Bozbay M
        • Eren M
        • Pehlivanoǧlu S.
        Hypertensive emergency due to pheochromocytoma crisis complicated with refractory hemodynamic collapse.
        Turk Kardiyol Dern Ars. 2015; 43: 727-729
        • Hernández Ramírez JM
        • Cárdenes León A
        • Gobind Sakhrani R
        Inverted tako-tsubo induced by pheochromocytoma.
        Rev Española Cardiol (English Ed). 2016; 69: 1107-1109
        • Touma T
        • Miyara T
        • Taba Y.
        A case of pheochromocytoma presenting with cardiopulmonary arrest.
        J Cardiol Cases. 2019; 20: 225-227
        • Burgan H
        • Celi J.
        A rare initial clinical presentation of pheochromocytoma.
        BMJ Case Rep. 2019; 12e226163