Cesaretti Manuela, Ansaldo Gianluca, Varaldo Emanuela, Assalino Michela, Trotta Manuela, Torre Giancarlo, Borgonovo Giacomo
Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genova, Italy.
Ann Ital Chir. 2010 Nov-Dec;81(6):439-43.
Tako-tsubo cardiomyopathy is a rapidly reversible form of acute heart failure triggered by stressful events that occur more frequently in postmenopausal women. A central role is supposed to be played by catecholamines and the association with pheocromocytoma is rare.
We describe a patient admitted for abdominal pain and suffering of hypertension pharmacologically treated. During hospitalization the patient presented cephalea and precordial pain with nausea and profuse sweating. ECG showed ST elevation and deep negative T wave. Blood tests were moderately elevated. Echo-cardiography reported a left ventricular apex akynesia and hyperkynesia of the base while coronarography was negative. As hypertension persisted the suspicion of pheocromocytoma arose. Urinary and blood catecholamines were mildly elevated and echography and Magnetic Resonance revealed a left adrenal gland mass. The diagnosis of pheocromocytoma was thus confirmed Left laparoscopic adrenalectomy was performed after adequate stabilization and preoperative pharmacological preparation by hydration, a-and f-blockers. Intraoperatively blood pressure was controlled by nitroprussiate, rapid half life beta-blockers (esmolol cloridrate). Post-operative course was uneventful and arterial pressure returned to normal as well as catecholamines values. Patient was discharged on the 5th post-operative day Five months afterwards the patient had normal arterial pressure without anti-hypertensive therapy and symptom free.
The case confirmed that tako-tsubo cardiomyopathy could be the first manifestation of tumors secreting catecholamines and that pheocromocytoma should be considered in patients with hypertension and acute stress-induced cardiomiopathy without evidence of acute coronary disease and with negative coronarography.
应激性心肌病是一种由应激事件引发的急性心力衰竭的快速可逆形式，在绝经后女性中更常见。儿茶酚胺被认为起核心作用，与嗜铬细胞瘤的关联罕见。
我们描述了一名因腹痛入院且接受药物治疗高血压的患者。住院期间，患者出现头痛、心前区疼痛、恶心和大量出汗。心电图显示ST段抬高和T波深倒置。血液检查结果中度升高。超声心动图报告左心室心尖运动减弱，心底运动增强，而冠状动脉造影结果为阴性。由于高血压持续存在，怀疑患有嗜铬细胞瘤。尿和血中的儿茶酚胺轻度升高，超声检查和磁共振成像显示左肾上腺有肿块。因此确诊为嗜铬细胞瘤。在通过补液、α和β受体阻滞剂进行充分的稳定和术前药物准备后，进行了左侧腹腔镜肾上腺切除术。术中通过硝普钠、快速半衰期β受体阻滞剂（艾司洛尔盐酸盐）控制血压。术后过程顺利，动脉血压和儿茶酚胺值均恢复正常。患者术后第5天出院。五个月后，患者未接受抗高血压治疗，动脉血压正常且无症状。
该病例证实应激性心肌病可能是分泌儿茶酚胺肿瘤的首发表现，对于高血压和急性应激性心肌病患者，在无急性冠状动脉疾病证据且冠状动脉造影阴性时，应考虑嗜铬细胞瘤。
