El Abidi Hamza, Ibrahimi Ahmed, Mikou Mohamed Ali, Iraqui Imane, Boualaoui Imad, Labbi Zined, Derqaoui Sabrine, Bernoussi Zakiya, El Sayegh Hashem, Nouini Yassine
Urology A Departement, University Hospital Ibn Sina, Rabat, Morocco.
Pathology Department, University Hospital Ibn Sina, Rabat, Morocco.
Radiol Case Rep. 2025 Apr 14;20(7):3309-3313. doi: 10.1016/j.radcr.2025.03.024. eCollection 2025 Jul.
Paragangliomas are rare neuroendocrine tumors that can secrete catecholamines, resulting in cardiovascular consequences such as catecholamine-induced cardiomyopathy and heart failure. The pathogenesis involves excessive catecholamine exposure, which causes myocardial damage, decreased cardiac function, and systemic consequences. We discuss the case of a 26-year-old adult woman who presented with dyspnea, orthopnea, and lower limb edema and was finally diagnosed with dilated cardiomyopathy. Echocardiography revealed an LVEF of 35%. Further investigation, including imaging and biochemical testing, revealed an abdominal paraganglioma compressing the renal arteries and markedly high plasma and urinary normetanephrine levels. A multidisciplinary team of cardiologists, endocrinologists, surgeons, and anesthesiologists worked together to enhance preoperative, intraoperative, and postoperative treatment. Preoperative alpha-blockade using phenoxybenzamine, followed by conservative beta-blockade, ensured hemodynamic stability. To avoid excessive catecholamine release, the tumor was carefully handled intraoperatively during surgical excision. The patient's clinical condition improved significantly after surgery, with catecholamine levels and heart function returning to normal.
副神经节瘤是一种罕见的神经内分泌肿瘤，可分泌儿茶酚胺，导致心血管后果，如儿茶酚胺诱导的心肌病和心力衰竭。其发病机制涉及儿茶酚胺暴露过多，这会导致心肌损伤、心脏功能下降以及全身后果。我们讨论了一名26岁成年女性的病例，她出现呼吸困难、端坐呼吸和下肢水肿，最终被诊断为扩张型心肌病。超声心动图显示左心室射血分数为35%。进一步检查，包括影像学和生化检测，发现一个腹部副神经节瘤压迫肾动脉，血浆和尿去甲变肾上腺素水平显著升高。心脏病专家、内分泌专家、外科医生和麻醉医生组成的多学科团队共同努力，加强术前、术中和术后治疗。术前使用酚苄明进行α受体阻滞，随后进行保守的β受体阻滞，确保了血流动力学稳定。为避免儿茶酚胺过度释放，手术切除肿瘤时在术中小心操作。术后患者的临床状况显著改善，儿茶酚胺水平和心脏功能恢复正常。
