ADRENERGIC MYOCARDITIS DUE TO PHEOCHROMOCYTOMA

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Am Coll Cardiol

Keywords

catecholamine, doxazosin, metadrenalin, nitroprusside sodium, adrenal tumor, adrenalectomy, adult, alpha adrenergic receptor blocking, apoptosis, cardiac index, cardiovascular magnetic resonance, case report, clinical article, conference abstract, diagnosis, dyspnea, forward heart failure, heart failure, heart function, heart palpitation, hemodynamics, human, human tissue, hypertension, laboratory test, male, myocarditis, parietal lobe, pheochromocytoma, subendocardium

Abstract

Background: Chronic adrenergic stimulation has adverse effects on cardiomyocytes including hypertrophy, apoptosis, and contraction band necrosis resulting in cardiac dysfunction. Case A 33-year-old male with no medical history presented with subacute palpitations, flushing, and dyspnea found to have LVEF of 10%, LVH, and apical thrombus with right parietal lobe infarct on CT. RHC showed bivencticular volume overload with low cardiac index and AKI. Blood pressures were unusually elevated. Cardiac MRI showed subendocardial LGE deposition consistent with myocarditis. Further imaging revealed a 4.3 x 3.9 cm left adrenal mass. Laboratory tests showed elevated total metanephrines and catecholamines raising concern for pheochromocytoma. He was transitioned from nitroprusside to doxazosin for alpha-blockade along with GDMT. He underwent adrenalectomy with pathology showing pheochromocytoma followed by normalization of cardiac function. Decision-making The patientʼs history of flushing and unusual hypertension in setting of low cardiac output prompted laboratory assessment with abdominal imaging which effectively confirmed the diagnosis. The removal of the adrenal tumor led to myocardial cure. Conclusion Adrenergic myocarditis is a rare condition associated with pheochromocytoma and can present with acute hemodynamic compromise. Clinical history is crucial for diagnosing and managing this uncommon disorder. Effective treatment requires a multidisciplinary approach. [Formula presented]

Volume

85

Issue

12

First Page

2880

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