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(Circulation. 2000;102:e11.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Pheochromocytoma-Induced Cardiomyopathy

Vamsi K. Mootha, MD; Jeremy Feldman, MD; Finn Mannting, MD; Gayle L. Winters, MD; Wendy Johnson, MD

From the Departments of Medicine, Cardiology, Nuclear Medicine, and Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Vamsi K. Mootha, MD, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115.

	Introduction

 
A34-year-old woman presented with recurrent 15-minute episodes of palpitations, lightheadedness, and chest tightness. ECGs obtained during these episodes revealed striking global T-wave inversions that resolved spontaneously 2 hours after each episode (Figure 1). Echocardiography revealed severe left ventricular dysfunction with an estimated ejection fraction of 20%. Cardiac catheterization demonstrated angiographically normal coronary arteries. A 24-hour urine collection for catecholamines showed an epinephrine level of 227 µg (normal, 2 to 24 µg) and a metanephrine level of 3803 µg (normal, 95 to 475 µg). Abdominal/pelvic MRI identified a right adrenal mass (Figure 2). ¹²³I-MIBG scintigram showed marked uptake in a single location corresponding to the right adrenal gland (Figure 3). The patient was diagnosed with an epinephrine-secreting pheochromocytoma and underwent an uncomplicated right adrenalectomy (Figure 4). Three months after surgery, the patient was asymptomatic. A repeat echocardiogram revealed normal ventricular function, and urine catecholamines remained negative.

View larger version (8K): [in this window] [in a new window]   Figure 1. A, Baseline ECG obtained while patient was asymptomatic. B, ECG captured during a symptomatic episode reveals diffuse T-wave inversions.

View larger version (94K): [in this window] [in a new window]   Figure 2. T2-weighted MRI reveals 3.2x2.8x3.6-cm high-signal lesion in right adrenal gland.

View larger version (31K): [in this window] [in a new window]   Figure 3. Twelve-millimeter coronal slices of 123I-MIBG abdominal scintigram. Note marked uptake below liver at level of right adrenal gland.

View larger version (70K): [in this window] [in a new window]   Figure 4. Right adrenalectomy surgical specimen containing pheochromocytoma. A, Gross appearance of bisected 32-g adrenalectomy specimen containing well-circumscribed 3.8-cm tumor with adjacent compressed uninvolved adrenal gland (top right). Necrosis is present, consisting of a 2.5x1.8-cm yellow area within mass surrounded by hemorrhagic rim. B, Portion of tumor before (left) and . . . [Full Text of this Article]