Endocrine Abstracts

Introduction: Described in 1990 by N Sato et al., Takotsubo syndrome (TS) is an acute myocardial dysfunction with the development of heart failure.

Objective: We present a description of the clinical case of ST after adrenalectomy for pheochromocytoma.

Results: Pheochromocytoma of the left adrenal gland (methanephrine 553.7 pg/ml (norm <65) and plasma normmetanephrine 458 pg/ml (norm <196) was verified in 27-year-old patient L. with hypertensive crisis. In connection with severe hypotension associated with doxazosin, 6% hydroxyethyl starch was infused. At endoscopic adrenalectomy, a transient increase in blood pressure and heart rate was observed, after compression of the left adrenal vein – severe vasoplegia, signs of acute left ventricular failure with the development of alveolar pulmonary edema. The ventilation parameters were adjusted, the left adrenal gland was removed along with the tumor. On artificial pulmanory ventilation with 100% oxygen, infusion of norepinephrine and mesatone: BP 115/75 mmHg, heart rate 138/min, central venous pressure +23 cm water column, saturation 90%, leukocytosis 18.4×10⁹/l, glycemia 13.4 mol/ , CK-MB 37 U/l, hsTnl 0.671 ng/ml (<0.016). ECG: subepicardial ischemia in the anteroseptal apical segment; LV echocardiography 36×57 mm, systolic gradient at the exit of the left ventricle 2.7 mmHg, ejection fraction of 30%, akinesis of the middle segments of the septum, anterior septum, anterior, lateral, posterior, lower walls of the LV, apical segments of the septum, anterior, lateral, lower walls of the LV; X-ray signs of cardiogenic edema of the right lung. The patient was diagnosed with: Takotsubo syndrome. Acute left ventricular failure, alveolar pulmonary edema. Cardiogenic shock. Acute renal injury. Treatment: Artificial pulmanory ventilation, norepinephrine and mesatone, clexane, iso-mik before stopping the clinical signs of pulmonary edema; in-blocker. After recovering consciousness, the patient was extubated, neurological deficit was absent, the therapy for acute renal injury was administrated. Subepicardial anterior widespread changes in the type of ischemia, deepening of the T wave in leads V2–V6, inversion of the T wave in III, aVF were observed on the ECG. The global systolic function of the LV was recovered, hypokinesis subsequently persisted in the apical segment. Against the background of anticoagulant therapy, in-blockers and ing-ACE, shortness of breath decreased and exercise tolerance was recovered.

Conclusion: When conducting an adrenalectomy, it is necessary to consider the possibility of developing stress-induced myocardial dysfunction.