The risk of development of perioperative myocardial lesions and acute left ventricular insufficiency in the patients presenting with pheochromocytoma
https://doi.org/10.14341/probl201359345-50
Abstract
Differential diagnostics of coronary heart disease (CHD) and catecholamine-induced cardiomyopathy was undertaken in 19 of the 106 patients presenting with pheochromocytoma. Group 1 included 13 patients having the history of acute myocardial infarction. Diagnostics of CHD was performed following the adequate preoperative alpha-blockade (supplemented by Β-blockade whenever indicated). Group 2 was comprised of 6 patients suffering pulmonary oedema (normotensive, 10-70 min after removal of the tumour) and showing the elevated levels of biomarkers of myocardial necrosis and/or ischemic-type changes of ECG in the early postoperative period. The clinically significant myocardial ischemia requiring correction was documented only in one of the 19 patients. The two groups were not significantly different in terms of the mean tumour size and duration of surgery, the quality of preoperative compensation, and intraoperative fluctuations of arterial pressure. The mean age of the patients in group 1 (47 years) was much higher than that in group 2 (29 years). All patients in group 2 exhibited the predominantly adrenalin-type secretion whereas 10 patients of group 1 had the noradrenalin-type secretion and two others mixed-type secretion with the predominance of noradrenalin release. It was shown that the patients with the predominantly adrenaline-type secretion by the tumour were at higher risk of pulmonary oedema. The possibility of application of alpha-methylparatyrosine having beneficial effect on contractile activity of myocardium as the main agent for preoperative preparation is discussed.
References
1. Priest W.M. Phaeochromocytoma with fatal myocardial infarction in a managed 22. BMJ 1952; 860-861.
2. Northfield T.C. Cardiac Complications of Phaochromocytoma. Br Heart J 1967; 29: 588.
3. Cohen C.D., Dent D.M. Phaeochromocytoma and acute cardiovascular death (with special reference to myocardial infarction. Postgrad Med J 1984; 60: 111-115.
4. Lebedevskaia V.P. Pathomorphological changes in the heart and its vessels in adrenal pheochromocytoma. Arkh Patol 1981; 43: 9: 26-30.
5. Zelinka T., Petrák O., Turková H., Holaj R. High incidence of cardiovascular complications in pheochromocytoma. Horm Metabol Res 2012; 44: 5: 379-384.
6. Kassim T.A., Clarke D.D., Mai V.Q., Clyde P.W., Mohamed Shakir K.M. Catecholamine-induced cardiomyopathy. Endocrinol Pract 2008; 14: 9: 1137-1149.
7. Liao W.B., Liu C.F., Hing-Wen Chiang H.W. Cardiovascular Manifestations of Pheochromocytoma. Am J Emer Med 2000; 5: 622-625.
8. Hass G.J., Tzagournis M., Boudoulas H. Pheochromocytoma: catecholamine-mediated electrocardiographic changes mimicking ischemia. Am Heart J 1988; 116: 1363-1365.
9. Van Braeckel P., Carlier S., Steelant P.J., Weyne L., Vanfleteren L. Perioperative management of phaeochromocytoma. Acta Anaesthesiol Belg 2009; 60: 1: 55-66.
10. Gianni M., Dentali F., Grandi A.M., Sumner G., Hiralal R., Lonn E.E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006; 27: 1523-1529.
11. Paur H., Wright P.T., Sikkel M.B., Tranter M.H. High levels of circulating epinephrine trigger apical cardiodepression in a Β2-adrenergic receptor/Gi-dependent manner: a new model of Takotsubo cardiomyopathy. Circulation 2012; 126: 6: 697-706.
12. Agarwal V., Kant G., Hans N., Messerli F.H. Takotsubo-like cardiomyopathy in pheochromocytoma. Int J Cardiol 2011; 153: 3: 241-248.
13. Koeth O., Mark B., Cornelius B., Senges J., Zeymer U. Cardiogenic shock after adrenalectomy for pheochromocytoma. Internist (Berl). 2007; 48: 2: 189-193.
14. Leaver S.K., Evans T.W. Acute respiratory distress syndrome. BMJ 2007; 335: 389-394.
15. Blom H.J., Karsdorp V., Birnie R., Davies G. Phaeochromocytoma as a cause of pulmonary oedema. Anaesthesia 1987; 42: 6: 646-650.
16. Coppens F., Tsicopoulos A., Marquette C.H., Proye C., Wallaert B., Tonnel A.B. Pheochromocytoma revealed by pulmonary edema. Rev Mal Resp 1989; 6: 5: 457-459.
17. Ford J., Rosenberg F., Chan N. Pheochromocytoma manifesting with shock presents a clinical paradox:a case report. Can Med Ass J 1997; 157: 923-925.
18. Mok C.C., Ip T.P., So C.C. Phaeochromocytoma with adult respiratory distress syndrome mimicking septicaemic shock. Med J Aust 1997; 166: 12: 634-635.
19. Naeije R., Yernault J.C., Goldstein M., Corhil A. Acute pulmonary oedema in a patient with phaeochromocytoma. Int Care Med 1978; 4: 3: 165-167.
20. O'Hikeys S., Hilton A.M., Whittaker J.S. Phaeochromocytoma associated with adult respiratory distress syndrome. Thorax 1987; 42: 157-158.
21. Peter W., Jacob B.G., Engelhardt D., Decker W. An usual cause of acute lung edema requiring artificial respiration in a 25-year-old patient. Adrenal pheochromocytoma. Internist (Berl) 2002; 43: 10: 1285-1288.
22. Porzig A., Matthay K.K., Dubois S., Pampaloni M., Damon L., Hawkins R., Goldsby R., Hollinger F., Fitzgerald P. Proteinuria in metastatic pheochromocytoma is associated with an increased risk of Acute Respiratory Distress Syndrome, spontaneously or after therapy with 131I-meta-iodobenzylguanidine (131I-MIBG). Horm Metabol Res 2012; 44(7):539-542. doi: 10.1055/s-0032-1311634.
23. van der Kleij F.G. Adult respiratory distress syndrome due to pheochromocytoma as the initial presentation of multiple endocrine neoplasia type IIA syndrome. Am J Med 1999; 107: 4: 401.
24. Malhotra S.K., Ramprabu K., Dutta A., Behera A. An unusual cause of respiratory distress and hypotension following removal of a pheochromocytoma. Can J Anaesth 2002; 49: 10: 1099-1100.
25. Touboul J.L., Sicard J.F., Cresson E., Michel F. Acute non-cardiogenic pulmonary edema during resection of a bladder paraganglioma (pheochromocytoma). Rev Pneumol Clin 1985; 41: 3: 197-199.
26. Theodore J., Robin E.D. Pathogenesis of neurogenic pulmonary oedema. Lancet 1975; 2: 7938: 749-751.
27. Theodore J., Robin E.D. Speculations on neurogenic pulmonary edema (NPE). Am Rev Resp Dis 1976; 113: 4: 405-411.
28. Malik A.B. Mechanisms of Neurogenic Pulmonary Edema.Circulat Res 1985; 57: 1-18.
29. Perry R.R. Surgical Management of Pheoclromocytoma with the Use of Metyrosine. Ann Surg 1990; 212: 5: 621-628.
30. Sand J., Salmi J., Saaristo J., Auvinen O. Preoperative treatment and survival of patients with pheochromocytomas. Ann Chir Gynaecol 1997; 86: 3: 230-232.
31. Steinsapir J., Carr A.A., Prisant L.M., Bransome E.D.Jr. Metyrosine and pheochromocytoma. Arch Int Med 1997; 157: 8: 901-906.
32. Koulouris S. Takotsubo Cardiomyopathy: the "Broken Heart" Syndrome. Hellenic J Cardiol 2010; 51: 451-457.
33. Delaney A., Bradford C., McCaffrey J., Bagshaw S.M., Lee R. Levosimendan for the treatment of acute severe heart failure: a meta-analysis of randomised controlled trials. Int J Cardiol 2010; 138: 3: 281-289.
34. Landoni G., Mizzi A., Biondi-Zoccai G., Bignami E., Prati P., Ajello V., Marino G., Guarracino F., Zangrillo A. Levosimendan reduces mortality in critically ill patients. A metaanalysis of randomized controlled studies. Min Anest 2010; 76: 4: 276-286.
35. Westaby S., Shahir A., Sadler G., Flynn F., Ormerod O. Mechanical bridge to recovery in pheochromocytoma myocarditis. Nat Rev Cardiol 2009; 6: 7: 482-487.
Review
For citations:
Kuznetsov A.B., Bel'tsevich D.G., Lysenko M.A., Kats L.E., Gomzhin I.S., Iukina M.I. The risk of development of perioperative myocardial lesions and acute left ventricular insufficiency in the patients presenting with pheochromocytoma. Problems of Endocrinology. 2013;59(3):45-50. (In Russ.) https://doi.org/10.14341/probl201359345-50
Views:
317
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
Email this article 
.jpg){kind=logo}
