Image in medicine
Cathecolaminergic storm with stress-induced cardiomyopathy secondary to pheochromocytoma
Tormenta catecolaminérgica con miocardiopatía de estrés secundaria a feocromocitoma
Núria Pueyo Balsellsa, Ignacio Barriusoa,
, Elena Gambó Rubertea, Sònia Gatiusb, Maite Santamaría Gómezc
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a Physician Specialist in Cardiology, Hospital Universitari Arnau de Vilanova de Lleida, Spain
b Department of Pathology, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida, Universitat de Lleida, CIBERONC, Spain
c Physician Specialist in General Surgery and Digestive System, Endocrine, Bariatric and Metabolic Surgery Section, Universitat de Lleida (UdL) Associate Professor, Hospital Universitari Arnau Vilanova de Lleida, Spain
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Emergent coronary angiography was performed showing no significant coronary stenosis. Echocardiography and ventriculography, were consistent with stress-induced cardiomyopathy (SC), showing akinesia of medial-apical segments (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1A</a>, <a class="elsevierStyleCrossRef" href="#sec0015">Video 1</a>). Additionally, a big mass on right kidney was observed from subcostal view (1B). Afterwards, the patient started experiencing hypertensive crisis along with headache, tremors and an erythemato-macular eruption in thorax and face (1C). Suspecting a pheochromocytoma crisis the patient was treated with intravenous infusion of phentolamine and nitroprusside and eventually with oral alpha and beta-blockers. Follow-up echocardiography displayed normalization of contractility, confirming SC. Urinary sample showed high level of catecholamines and computed tomography confirmed the presence of a giant tumoral mass (79<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>59<span class="elsevierStyleHsp" style=""></span>mm) on the right adrenal gland (1D). A laparoscopic adrenalectomy was performed (1E) and histology (1F) showing nests of polygonal cells with eosinophilic granular cytoplasm separated by connective tracts and positivity for synaptophysinconfirmed the diagnosis of pheochromocytoma. In the extension study, the presence of a medullary thyroid carcinoma was detected, encompassing the diagnosis as a MEN-2.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Pheochromocytoma is a rare catecholamine-producing neuroendocrine tumour, which can be included in the diagnosis of a MEN-II in up to 50% and around 4–18% of SC is secondary to pheochromocytoma.</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">Informed consent from the patient has been obtained, and the development of this work has adhered to all ethical considerations, ensuring the protection and confidentiality of personal data.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">The work has not received any external funding or support.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">None of the authors have any conflicts of interest relevant to the subject matter in this paper.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Informed consent" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0035" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0020" ] ] ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1083 "Ancho" => 1339 "Tamanyo" => 344482 ] ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 937620 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000016200000009/v1_202405080526/S0025775323006681/v1_202405080526/en/main.assets" "Apartado" => array:4 [ "identificador" => "64289" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imágenes médicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000016200000009/v1_202405080526/S0025775323006681/v1_202405080526/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323006681?idApp=UINPBA00004N" ]
