Clinical Characteristics of Transient Cardiomyopathy in Patients with Surgically Resected Pheochromocytoma and Paraganglioma

Abstract

Background Because pheochromocytoma and paraganglioma (PPGL) release catecholamines into circulation and result in increased heart rate and blood pressure (BP), it can cause transient cardiomyopathy, so called catecholamine cardiomyopathy. Recently, widespread use of imaging studies can detect these tumors before the onset of symptoms. We investigated clinical profiles of transient cardiomyopathy in patients with surgically resected PPGLs. Methods From January 2005 to December 2017, all consecutive patients with surgically-resected PPGLs in two tertiary teaching hospitals in Korea were retrospectively enrolled and studied. Results One-hundred and eleven patients (54 men, 52 ± 16 years old) were included. PPGLs were detected during the work-up of cardiomyopathy in 7 patients (6.3%). Sixteen patients (14.4%) were confirmed during evaluation of paroxysmal BP elevation and the rest were diagnosed incidentally during routine screening. Clinical features of patients with PPGL-related cardiomyopathy were summarized in the Table. Chest pain was the main symptom and ST change and T-wave abnormalities were commonly found in the electrocardiogram. Four patients showed apical ballooning and three had inverted Takotsubo pattern (basal ballooning). All patients were recovered within 12 days (range: 3 ∼ 12 days). One patient had cardiogenic shock and treated with extracorporeal membrane oxygenator for 12 days and continuous renal replacement therapy for 25 days. Conclusions Because 7 patients (6.3%) had transient cardiomyopathy in 111 patients with surgically resected PPGLs, the presence of transient cardiomyopathy can be a clue for PPGLs and physicians should consider PPGL as a differential diagnosis.