Endocrine Abstracts

Catecholamine-induced cardiomyopathy is a rare presentation of pheochromocytoma (PCC) with typical and atypical subtypes. These patients are associated with worse rates of morbidity and mortality compared to patients with PCC that were incidentally found. Frequently, these patients would present in the emergency setting with cardiac symptoms that may be difficult to distinguish from ischemic cardiomyopathy, and hence patients may be prescribed cardiac treatment in the form of angioplasty or coronary artery bypass grafting (CABG). In our case series, we discuss 4 cases in our tertiary centre since 2017, presenting with cardiac symptoms suggestive of takotsubo cardiomyopathy and were later diagnosed with PCC as well. 2 patients presented with global hypokinesia of the heart on a background of a normal coronary angiogram, that resolved after excision of the PCC. 2 patients that presented diagnosed with concurrent triple vessel coronary disease and pheochromocytomas, underwent CABG and were found to have relatively normal coronary arteries, these patients were only able to wean off anti-hypertensives after excision of the PCC. On histology, 3 PCC were extra-adrenal and these tested positive for genetic mutations (2 had SDH-B expression). At the time of diagnosis, it is challenging to establish that cardiomyopathy is solely due to catecholamine-excess, which would dictate the best management approach of excision of the PCC. These patients are also at higher risk of peri-operative complications of cardiac arrest and respiratory failure. It is essential to achieve early appropriate diagnosis, stabilisation with alpha blockade before beta-blockade before PCC surgery.