Endocrine Abstracts

Background: Tako-tsubo cardiomyopathy (TTC) is a non-ischemic condition manifested with a temporary weakening of the myocardium after an acute stress. The association between pheochromocytoma (PHEO) and TTC is rare and is attributed to catecholamine excess. We present a case of a young women with an atypical manifestation of PHEO.

Clinical case: Patient, F, aged 37, known with multinodular goiter with hypothyroidism for several years, having paroxysmal hypertension from the age of 35 years (max. 220/170 mmHg) accompanied by frontal-parietal headache, sweating, hands pallor, inferior limb paresthesia, is referred to surgery for thyroidectomy. Immediately after anesthesia induction, the patient presented ventricular fibrillation with cardio-respiratory arrest. She is resuscitated and converted to sinus rhythm. ECG shows sinus rhythm, VA: 80 bpm, negative T wave in DI, DII, aVL, aVF, V3-V6. Echocardiography: dilated left ventricle, apical-septal and 1/3 apical-anterior dyskinesia, EF=30%; she had normal epicardial coronary arteries at coronarography. Few days later, EF=44%, apical akinesia, hemodynamic stable and was diagnosed with TTC. Subsequent endocrine evaluation reveals plasma free normetanephrines 557 pg/ml (20–200), urinary normetanephrines 842 ug/24 h (100–600), Chromogranin A 660 ng/ml (20–100), normal plasma free metanephrines and cortisol secretion. CT scan showed right adrenal mass of 1.95/2.31 cm. Negative RET mutation. After adequate preoperative treatment, she underwent an uneventful laparoscopic adrenal surgery, with pathological confirmation of a PHEO. One year later, the patient underwent thyroidectomy without any incidents.

Conclusion: The particularity of our case is the association between a stressful condition and a PHEO crisis which triggered Takotsubo cardiomyopathy. Although rare, PHEO should be considered in the differential diagnosis of TTC especially in younger patients.