Iio Kohei, Sakurai Shunpei, Kato Tamon, Nishiyama Shigeki, Hata Takeki, Mawatari Eiichiro, Suzuki Chihiro, Takekoshi Kazuhiro, Higuchi Kayoko, Aizawa Toru, Ikeda Uichi
Department of Cardiology, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, Nagano, 390-8510, Japan.
Heart Vessels. 2013 Mar;28(2):255-63. doi: 10.1007/s00380-012-0247-4. Epub 2012 Apr 5.
A 29-year-old female patient presented with shock and dyspnea due to heart failure and pulmonary edema. Echocardiography indicated excessive contraction limited to the left ventricular apex and akinesis of the basal and middle ventricle, which were confirmed by emergency left ventriculography. The finding was diagnostic of inverted Takotsubo cardiomyopathy. An abdominal computed tomography scan showed a tumor in the left adrenal gland with a central low-density area, and the plasma and urinary catecholamines were strikingly elevated. Taken together, these findings suggested the presence of a hemorrhagic pheochromocytoma. A myocardial biopsy in the very acute stage on the day of admission revealed neutrophilic infiltration and contraction-band necrosis, which was indistinguishable from the previously reported pathology in the acute phase of idiopathic Takotsubo cardiomyopathy without pheochromocytoma. The diagnosis of pheochromocytoma in this case was confirmed 7 weeks later by surgical removal of the left adrenal gland with massive hemorrhage at the center of the pheochromocytoma. The marked similarity of the endomyocardial pathology between this case and cases with idiopathic Takotsubo cardiomyopathy strongly points to catecholamine excess as a common causality for Takotsubo cardiomyopathy with or without pheochromocytoma.
一名29岁女性患者因心力衰竭和肺水肿出现休克和呼吸困难。超声心动图显示仅左心室心尖部收缩过度，基底部和中间部心室运动不能，急诊左心室造影证实了这一情况。该发现诊断为倒灌型应激性心肌病。腹部计算机断层扫描显示左肾上腺有一个肿瘤，中央为低密度区，血浆和尿儿茶酚胺显著升高。综合这些发现提示存在出血性嗜铬细胞瘤。入院当天极急性期的心肌活检显示中性粒细胞浸润和收缩带坏死，这与先前报道的无嗜铬细胞瘤的特发性应激性心肌病急性期病理表现无法区分。7周后，通过手术切除左肾上腺，嗜铬细胞瘤中央有大量出血，证实了该病例中嗜铬细胞瘤的诊断。该病例与特发性应激性心肌病病例的心内膜病理表现显著相似，有力地表明儿茶酚胺过量是伴或不伴嗜铬细胞瘤的应激性心肌病的共同病因。
