Anna Riester1, Dirk Weismann1, Marcus Quinkler1, Urs D Lichtenauer1, Sandra Sommerey1, Roland Halbritter1, Randolph Penning1, Christine Spitzweg1, Jochen Schopohl1, Felix Beuschlein1, Martin Reincke2. 1. Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany. 2. Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Ludwig-Maximilians-Universität, Ziemssenstr. 1, D-80336 Munich, GermanyMedizinische Klinik und Poliklinik IUniversitätsklinikum Würzburg, Würzburg, GermanyEndokrinologie in CharlottenburgBerlin, GermanyHelios Klinik SchwerinSchwerin, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, GermanyFacharztpraxisPfaffenhofen, GermanyInstitut für RechtsmedizinMedizinische Klinik und Poliklinik IIKlinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany martin.reincke@med.uni-muenchen.de.
Abstract
OBJECTIVE: Pheochromocytomas are rare chromaffin cell-derived tumors causing paroxysmal episodes of headache, palpitation, sweating and hypertension. Life-threatening complications have been described in case reports and small series. Systematic analyses are not available. We took an opportunity of a large series to make a survey. DESIGN AND METHODS: We analyzed records of patients diagnosed with pheochromocytomas in three geographically spread German referral centers between 2003 and 2012 (n=135). RESULTS: Eleven percent of the patients (ten women, five men) required in-hospital treatment on intensive care units (ICUs) due to complications caused by unsuspected pheochromocytomas. The main reasons for ICU admission were acute catecholamine induced Tako-Tsubo cardiomyopathy (n=4), myocardial infarction (n=2), acute pulmonary edema (n=2), cerebrovascular stroke (n=2), ischemic ileus (n=1), acute renal failure (n=2), and multi organ failure (n=1). One patient required extracorporeal membrane oxygenation due to a hypertensive crisis with lung edema occurring during delivery (n=1). Two patients died of refractory shock and pheochromocytomas were found postmortem. Two patients were treated by emergency surgery. Compared to pheochromocytoma patients without life-threatening events (n=120), patients with complications had a significant larger maximal tumor diameter (7.0 vs 4.5 cm, P<0.01), higher levels of catecholamines (20- vs ninefold upper limit of normal, P<0.01), and tended to be younger (42 vs 51 years, P=0.05). CONCLUSION: Although pheochromocytomas are rare, they are likely to be associated with a life-threatening situation. Clinicians have to be aware of these situations and perform a timely diagnosis.
OBJECTIVE:Pheochromocytomas are rare chromaffin cell-derived tumors causing paroxysmal episodes of headache, palpitation, sweating and hypertension. Life-threatening complications have been described in case reports and small series. Systematic analyses are not available. We took an opportunity of a large series to make a survey. DESIGN AND METHODS: We analyzed records of patients diagnosed with pheochromocytomas in three geographically spread German referral centers between 2003 and 2012 (n=135). RESULTS: Eleven percent of the patients (ten women, five men) required in-hospital treatment on intensive care units (ICUs) due to complications caused by unsuspected pheochromocytomas. The main reasons for ICU admission were acute catecholamine induced Tako-Tsubo cardiomyopathy (n=4), myocardial infarction (n=2), acute pulmonary edema (n=2), cerebrovascular stroke (n=2), ischemic ileus (n=1), acute renal failure (n=2), and multi organ failure (n=1). One patient required extracorporeal membrane oxygenation due to a hypertensive crisis with lung edema occurring during delivery (n=1). Two patients died of refractory shock and pheochromocytomas were found postmortem. Two patients were treated by emergency surgery. Compared to pheochromocytomapatients without life-threatening events (n=120), patients with complications had a significant larger maximal tumor diameter (7.0 vs 4.5 cm, P<0.01), higher levels of catecholamines (20- vs ninefold upper limit of normal, P<0.01), and tended to be younger (42 vs 51 years, P=0.05). CONCLUSION: Although pheochromocytomas are rare, they are likely to be associated with a life-threatening situation. Clinicians have to be aware of these situations and perform a timely diagnosis.
Authors: Mark R Heckle; David M Flatt; Yao Sun; Salvatore Mancarella; Tony N Marion; Ivan C Gerling; Karl T Weber Journal: Heart Fail Rev Date: 2016-03 Impact factor: 4.214
Authors: Matthew A Nazari; Jared S Rosenblum; Mark C Haigney; Douglas R Rosing; Karel Pacak Journal: J Am Coll Cardiol Date: 2020-07-28 Impact factor: 24.094