J Korean Med Sci.  2008 Apr;23(2):350-354. 10.3346/jkms.2008.23.2.350.

Catastrophic Catecholamine-Induced Cardiomyopathy Mimicking Acute Myocardial Infarction, Rescued by Extracorporeal Membrane Oxygenation (ECMO) in Pheochromocytoma

• Suh IW
• Lee CW
• Kim YH
• Hong MK
• Lee JW
• Kim JJ
• Park SW
• Park SJ

• KMID: 1713475
• DOI: http://doi.org/10.3346/jkms.2008.23.2.350

Abstract

Pheochromocytoma is a rare disorder and functioning tumor composed of chromaffin cells that secrete catecholamines. Patients with a pheochromocytoma 'crisis' have a high mortality in spite of aggressive therapy. We present a case with a severe acute catecholamine cardiomyopathy presenting ST segment elevation with cardiogenic shock after hemorrhage into a left suprarenal tumor. Intra-aortic balloon pump (IABP) support, combined with inotropic therapy, was performed. However, the patient deteriorated rapidly and was unresponsive to a full dose of inotropics and IABP. We decided to apply extracorporeal membrane oxygenation (ECMO) device for the patient. His clinical state began to improve 3 days after ECMO. After achieving hemodynamic stabilization, he underwent successful laparoscopic left adrenalectomy. He needed no further cardiac medication after discharge.

Keyword

Shock, Cardiogenic; Catecholamines; Intra-Aortic Balloon Pumping; Extracorporeal Membrane Oxygenation; Pheochromocytoma

MeSH Terms

Adrenal Glands/pathology
Adult
Cardiomyopathies/*diagnosis/*etiology
Catecholamines/*adverse effects
Coronary Angiography/methods
Diagnosis, Differential
Electrocardiography/methods
Extracorporeal Membrane Oxygenation/*methods
Humans
Intra-Aortic Balloon Pumping
Male
Myocardial Infarction/*diagnosis
Pheochromocytoma/*therapy
Time Factors
Tomography, X-Ray Computed/methods

Figure

• 

  Fig. 1 (A) Initial ECG at emergency room showed left ventricular hypertrophy and ST depression in precordial leads. (B) Follow-up ECG showed ST elevation when abrupt hypotension occurred.

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  Fig. 2 The trend of cardiac enzymes.

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  Fig. 3 Coronary angiography shows near-normal coronary artery. (A) Right coronary artery and (B) Left coronary arteries.

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  Fig. 4 The graph shows the typical hemodynamic pattern of an acute cardiac events: a low SBP with the need for aggressive inotropic support and with good response to inotrophic agents. IABP and ECMO support and fluid therapy restored cardiac output during the first three days. Continuous cardiogenic shock was treated with dobutamine and norepinephrine temporarily. Continuous inotropic agents were discontinued at day 5. IABP, intra-aortic balloon pump, ECMO, extracorporeal membrane oxygenation, SBP, systolic blood pressure.

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  Fig. 5 (A) Abdominal computed tomography (CT) scan shows multiple sepated and well-encapsulated mass with intratumoral hemorrhage. (B) Three years later CT showed an enhanced 4.2×3.5 ×3 cm sized mass with septated central necrosis (comparison between 2002 and 2005, arrows indicate tumors).

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  Fig. 6 Left adrenal gland is a lump of soft mass (4.2×3.5×3 cm) with weight 28 gm. The cut surface of the mass is yellowish tan and soft with central hemorrhagic and necrotic areas.

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  Fig. 7 ECG after removal of tumor showed left ventricular hypertrophy without ST change.

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