Sethi Prince, Chang Guy Vin, Gowda Smitha Narayana, Elnair Radowan, Fenner Randall, Lamfers Randall
Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Department of Endocrinology, Sanford USD Medical Center, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
S D Med. 2020 Feb;73(2):78-80.
Catecholamine-induced cardiomyopathy (CIC) and pheochromocytoma are both rare entities, and their exact incidence and prevalence are unknown. Pheochromocytoma has been implicated as one of the causes of CIC or Takotsubo syndrome (TTS) by means of case reports and retrospective reviews. However, the evaluation of any patient with TTS and pheochromocytoma is often faced with multiple challenges due to its rarity and atypical presentations, which subsequently leads to delay in diagnosis. Here, we present a case of a 51-year old female who had three distinct episodes of TTS and now presented in a hypertensive emergency with angina, palpitations, headache, nausea, and vomiting. She was treated for non-ST elevation myocardial infarction (NSTEMI) but coronary angiogram revealed patent coronary arteries. Due to the paroxysmal nature of her hypertensive emergencies and variable blood pressure response, pheochromocytoma was suspected. On further evaluation, she was found to have elevated metanephrines and a 6.3 cm left adrenal mass on CT scan. This case emphasizes the importance of considering or identifying pheochromocytoma as an underlying primary etiology for recurrent episodes of TTS and related concerns such as choice of anti-hypertensive agents.
儿茶酚胺诱导性心肌病（CIC）和嗜铬细胞瘤均为罕见病症，其确切发病率和患病率尚不清楚。通过病例报告和回顾性研究，嗜铬细胞瘤被认为是CIC或Takotsubo综合征（TTS）的病因之一。然而，由于TTS和嗜铬细胞瘤罕见且临床表现不典型，对任何患有TTS和嗜铬细胞瘤的患者进行评估时往往面临多重挑战，进而导致诊断延误。在此，我们报告一例51岁女性患者，她曾三次发作典型的TTS，此次因高血压急症伴心绞痛、心悸、头痛、恶心和呕吐前来就诊。她最初按非ST段抬高型心肌梗死（NSTEMI）接受治疗，但冠状动脉造影显示冠状动脉通畅。由于其高血压急症的阵发性特点以及血压反应多变，怀疑为嗜铬细胞瘤。进一步评估发现，她的间甲肾上腺素水平升高，CT扫描显示左肾上腺有一个6.3厘米的肿块。该病例强调了将嗜铬细胞瘤视为TTS复发的潜在主要病因以及相关问题（如抗高血压药物的选择）的重要性。
