Progress in the diagnosis and treatment of catecholamine-induced cardiomyopathy in pheochromocytoma/paraganglioma_West China Medical Journal

Authors：

XIAO Yunfeng ¹ ,  YANG Zongke ²

1. School of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
2. Department of Urology, Dianjiang County People’s Hospital, Chongqing 408300, P. R. China;

Corresponding author：

YANG Zongke, Email: 9254817@qq.com

Keywords：

Pheochromocytoma; paraganglioma; catecholamine-induced cardiomyopathy; Takotsubo cardiomyopathy; dilated cardiomyopathy; hypertrophic cardiomyopathy

DOI：

10.7507/1002-0179.202309149

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Catecholamine-induced cardiomyopathy in pheochromocytoma/paraganglioma (PPGL) is a potential fatal cardiovascular complication caused by excessive secretion of catecholamines by PPGL, leading to structural changes and functional abnormalities in the heart. According to the morphology and function of the heart, it is clinically divided into three types: dilated cardiomyopathy, Takotsubo cardiomyopathy, and hypertrophic cardiomyopathy. The treatment of catecholamine-induced cardiomyopathy in PPGL requires attention to drug selection, application of life support equipment, and perioperative management. Most patients with cardiac dysfunction can effectively improve after tumor resection. This article mainly reviews the diagnosis and treatment of catecholamine-induced cardiomyopathy in PPGL.

Citation： XIAO Yunfeng, YANG Zongke. Progress in the diagnosis and treatment of catecholamine-induced cardiomyopathy in pheochromocytoma/paraganglioma. West China Medical Journal, 2024, 39(4): 635-639. doi: 10.7507/1002-0179.202309149 Copy

1.	Mete O, Asa SL, Gill AJ, et al. Overview of the 2022 WHO classification of paragangliomas and pheochromocytomas. Endocr Pathol, 2022, 33(1): 90-114.
2.	Nazari MA, Rosenblum JS, Haigney MC, et al. Pathophysiology and acute management of tachyarrhythmias in pheochromocytoma: JACC review topic of the week. J Am Coll Cardiol, 2020, 76(4): 451-464.
3.	Pacak K. New biology of pheochromocytoma and paraganglioma. Endocr Pract, 2022, 28(12): 1253-1269.
4.	Kumar A, Pappachan JM, Fernandez CJ. Catecholamine-induced cardiomyopathy: an endocrinologist’s perspective. Rev Cardiovasc Med, 2021, 22(4): 1215-1228.
5.	Lenders JWM, Kerstens MN, Amar L, et al. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens, 2020, 38(8): 1443-1456.
6.	Docherty JR. The pharmacology of α1-adrenoceptor subtypes. Eur J Pharmacol, 2019, 855: 305-320.
7.	Santos JRU, Brofferio A, Viana B, et al. Cardiomyopathy in pheochromocytoma: how to manage a rare complication in a rare disease?. Horm Metab Res, 2019, 51(7): 458-469.
8.	Szatko A, Glinicki P, Gietka-Czernel M. Pheochromocytoma/paraganglioma-associated cardiomyopathy. Front Endocrinol (Lausanne), 2023, 14: 1204851.
9.	Gupta G, Pacak K, AACE Adrenal Scientific Committee. Precision medicine: an update on genotype/biochemical phenotype relationships in pheochromocytoma/paraganglioma patients. Endocr Pract, 2017, 23(6): 690-704.
10.	Gordan R, Gwathmey JK, Xie LH. Autonomic and endocrine control of cardiovascular function. World J Cardiol, 2015, 7(4): 204-214.
11.	Dhalla NS. Formation of aminochrome leads to cardiac dysfunction and sudden cardiac death. Circ Res, 2018, 123(4): 409-411.
12.	Wang Y, Yu X, Huang Y. Predictive factors for catecholamine-induced cardiomyopathy in patients with pheochromocytoma and paraganglioma. Front Endocrinol (Lausanne), 2022, 13: 853878.
13.	Zhao L, Meng X, Mei Q, et al. Risk Factors for cardiac complications in patients with pheochromocytoma and paraganglioma: a retrospective single-center study. Front Endocrinol (Lausanne), 2022, 13: 877341.
14.	Amadio P, Zarà M, Sandrini L, et al. Depression and cardiovascular disease: the viewpoint of platelets. Int J Mol Sci, 2020, 21(20): 7560.
15.	Amar J, Brunel J, Cardot Bauters C, et al. Genetic biomarkers of life-threatening pheochromocytoma-induced cardiomyopathy. Endocr Relat Cancer, 2022, 29(5): 267-272.
16.	Zhang R, Gupta D, Albert SG. Pheochromocytoma as a reversible cause of cardiomyopathy: analysis and review of the literature. Int J Cardiol, 2017, 249: 319-323.
17.	Frey SM, Zellweger MJ, Glatz K, et al. Phaeochromocytoma-induced secondary takotsubo syndrome. Eur Heart J Cardiovasc Imaging, 2023, 24(6): e105.
18.	Ghadri JR, Y-Hassan S, Lüscher TF, et al. Pheochromocytoma triggers takotsubo syndrome. Eur Heart J, 2019, 40(24): 1990.
19.	Pätz T, Santoro F, Cetera R, et al. Trigger-associated clinical implications and outcomes in takotsubo syndrome: results from the multicenter GEIST registry. J Am Heart Assoc, 2023, 12(14): e028511.
20.	Y-Hassan S, Falhammar H. Clinical features, complications, and outcomes of exogenous and endogenous catecholamine-triggered Takotsubo syndrome: a systematic review and meta-analysis of 156 published cases. Clin Cardiol, 2020, 43(5): 459-467.
21.	Maron BJ, Desai MY, Nishimura RA, et al. Management of hypertrophic cardiomyopathy: JACC state-of-the-art review. J Am Coll Cardiol, 2022, 79(4): 390-414.
22.	Wani A, Adil A, Gardezi SAA, et al. Pheochromocytoma presenting as hypertrophic obstructive cardiomyopathy. JAMA Cardiol, 2021, 6(8): 974-976.
23.	Alamri A, Oriez C, Brenier M, et al. A case of late-detected pheochromocytoma in a young patient with resistant hypertension and hypertrophic cardiomyopathy. Am J Hypertens, 2020, 3: hpaa126.
24.	Dobrowolski P, Januszewicz A, Klisiewicz A, et al. Left ventricular structural and functional alterations in patients with pheochromocytoma/paraganglioma before and after surgery. JACC Cardiovasc Imaging, 2020, 13(12): 2498-2509.
25.	Elenkova A, Shabani R, Kinova E, et al. Global longitudinal strain as a marker for systolic function in patients with pheochromocytomas. Endocr Relat Cancer, 2020, 27(10): 561-570.
26.	Cuspidi C, Gherbesi E, Faggiano A, et al. Targeting left ventricular mechanics in patients with pheochromocytoma/paraganglioma: an updated meta-analysis. Am J Hypertens, 2023, 36(6): 333-340.
27.	Buitenwerf E, Osinga TE, Timmers HJLM, et al. Efficacy of α-blockers on hemodynamic control during pheochromocytoma resection: a randomized controlled trial. J Clin Endocrinol Metab, 2020, 105(7): 2381-2391.
28.	Gruber LM, Jasim S, Ducharme-Smith A, et al. The role for metyrosine in the treatment of patients with pheochromocytoma and paraganglioma. J Clin Endocrinol Metab, 2021, 106(6): e2393-e2401.
29.	Ommen SR, Semsarian C. Hypertrophic cardiomyopathy: a practical approach to guideline directed management. Lancet, 2021, 398(10316): 2102-2108.
30.	Yu M, Du B, Yao S, et al. Von Hippel-Lindau syndrome with a rare complication of dilated cardiomyopathy: a case report. BMC Cardiovasc Disord, 2022, 22(1): 489.
31.	Wang FZ, Wei WB, Li X, et al. The cardioprotective effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin in rats with isoproterenol-induced cardiomyopathy. Am J Transl Res, 2021, 13(9): 10950-10961.
32.	Fagundes GFC, Almeida MQ. Perioperative management of pheochromocytomas and sympathetic paragangliomas. J Endocr Soc, 2022, 6(2): bvac004.
33.	Casey RT, Challis BG, Pitfield D, et al. Management of an acute catecholamine-induced cardiomyopathy and circulatory collapse: a multidisciplinary approach. Endocrinol Diabetes Metab Case Rep, 2017, 2017: 17-0122.
34.	Dominedò C, D’Avino E, Martinotti A, et al. A rare pheochromocytoma complicated by cardiogenic shock and posterior reversible encephalopathy syndrome: case report. Eur Heart J Case Rep, 2021, 5(2): ytaa513.
35.	Geller BJ, Sinha SS, Kapur NK, et al. Escalating and de-escalating temporary mechanical circulatory support in cardiogenic shock: a scientific statement from the American Heart Association. Circulation, 2022, 146(6): e50-e68.
36.	Matteucci M, Kowalewski M, Fina D, et al. Extracorporeal life support for phaeochromocytoma-induced cardiogenic shock: a systematic review. Perfusion, 2020, 35(Suppl 1): 20-28.
37.	Nakamura M, Imamura T, Fukui T, et al. Successful management of pheochromocytoma crisis with cardiogenic shock by percutaneous left ventricular assist device. J Cardiovasc Dev Dis, 2022, 9(3): 71.
38.	Albulushi A, Zolty R, Lowes B, et al. Perioperative management of pheochromocytoma resection in a patient with a continuous flow left ventricular assist device. J Saudi Heart Assoc, 2020, 32(2): 233-235.
39.	Zelinka T, Petrák O, Turková H, et al. High incidence of cardiovascular complications in pheochromocytoma. Horm Metab Res, 2012, 44(5): 379-384.
40.	Batisse-Lignier M, Pereira B, Motreff P, et al. Acute and chronic pheochromocytoma-induced cardiomyopathies: different prognoses?: a systematic analytical review. Medicine (Baltimore), 2015, 94(50): e2198.
41.	Giavarini A, Chedid A, Bobrie G, et al. Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma. Heart, 2013, 99(19): 1438-1444.

1. Mete O, Asa SL, Gill AJ, et al. Overview of the 2022 WHO classification of paragangliomas and pheochromocytomas. Endocr Pathol, 2022, 33(1): 90-114.
2. Nazari MA, Rosenblum JS, Haigney MC, et al. Pathophysiology and acute management of tachyarrhythmias in pheochromocytoma: JACC review topic of the week. J Am Coll Cardiol, 2020, 76(4): 451-464.
3. Pacak K. New biology of pheochromocytoma and paraganglioma. Endocr Pract, 2022, 28(12): 1253-1269.
4. Kumar A, Pappachan JM, Fernandez CJ. Catecholamine-induced cardiomyopathy: an endocrinologist’s perspective. Rev Cardiovasc Med, 2021, 22(4): 1215-1228.
5. Lenders JWM, Kerstens MN, Amar L, et al. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens, 2020, 38(8): 1443-1456.
6. Docherty JR. The pharmacology of α1-adrenoceptor subtypes. Eur J Pharmacol, 2019, 855: 305-320.
7. Santos JRU, Brofferio A, Viana B, et al. Cardiomyopathy in pheochromocytoma: how to manage a rare complication in a rare disease?. Horm Metab Res, 2019, 51(7): 458-469.
8. Szatko A, Glinicki P, Gietka-Czernel M. Pheochromocytoma/paraganglioma-associated cardiomyopathy. Front Endocrinol (Lausanne), 2023, 14: 1204851.
9. Gupta G, Pacak K, AACE Adrenal Scientific Committee. Precision medicine: an update on genotype/biochemical phenotype relationships in pheochromocytoma/paraganglioma patients. Endocr Pract, 2017, 23(6): 690-704.
10. Gordan R, Gwathmey JK, Xie LH. Autonomic and endocrine control of cardiovascular function. World J Cardiol, 2015, 7(4): 204-214.
11. Dhalla NS. Formation of aminochrome leads to cardiac dysfunction and sudden cardiac death. Circ Res, 2018, 123(4): 409-411.
12. Wang Y, Yu X, Huang Y. Predictive factors for catecholamine-induced cardiomyopathy in patients with pheochromocytoma and paraganglioma. Front Endocrinol (Lausanne), 2022, 13: 853878.
13. Zhao L, Meng X, Mei Q, et al. Risk Factors for cardiac complications in patients with pheochromocytoma and paraganglioma: a retrospective single-center study. Front Endocrinol (Lausanne), 2022, 13: 877341.
14. Amadio P, Zarà M, Sandrini L, et al. Depression and cardiovascular disease: the viewpoint of platelets. Int J Mol Sci, 2020, 21(20): 7560.
15. Amar J, Brunel J, Cardot Bauters C, et al. Genetic biomarkers of life-threatening pheochromocytoma-induced cardiomyopathy. Endocr Relat Cancer, 2022, 29(5): 267-272.
16. Zhang R, Gupta D, Albert SG. Pheochromocytoma as a reversible cause of cardiomyopathy: analysis and review of the literature. Int J Cardiol, 2017, 249: 319-323.
17. Frey SM, Zellweger MJ, Glatz K, et al. Phaeochromocytoma-induced secondary takotsubo syndrome. Eur Heart J Cardiovasc Imaging, 2023, 24(6): e105.
18. Ghadri JR, Y-Hassan S, Lüscher TF, et al. Pheochromocytoma triggers takotsubo syndrome. Eur Heart J, 2019, 40(24): 1990.
19. Pätz T, Santoro F, Cetera R, et al. Trigger-associated clinical implications and outcomes in takotsubo syndrome: results from the multicenter GEIST registry. J Am Heart Assoc, 2023, 12(14): e028511.
20. Y-Hassan S, Falhammar H. Clinical features, complications, and outcomes of exogenous and endogenous catecholamine-triggered Takotsubo syndrome: a systematic review and meta-analysis of 156 published cases. Clin Cardiol, 2020, 43(5): 459-467.
21. Maron BJ, Desai MY, Nishimura RA, et al. Management of hypertrophic cardiomyopathy: JACC state-of-the-art review. J Am Coll Cardiol, 2022, 79(4): 390-414.
22. Wani A, Adil A, Gardezi SAA, et al. Pheochromocytoma presenting as hypertrophic obstructive cardiomyopathy. JAMA Cardiol, 2021, 6(8): 974-976.
23. Alamri A, Oriez C, Brenier M, et al. A case of late-detected pheochromocytoma in a young patient with resistant hypertension and hypertrophic cardiomyopathy. Am J Hypertens, 2020, 3: hpaa126.
24. Dobrowolski P, Januszewicz A, Klisiewicz A, et al. Left ventricular structural and functional alterations in patients with pheochromocytoma/paraganglioma before and after surgery. JACC Cardiovasc Imaging, 2020, 13(12): 2498-2509.
25. Elenkova A, Shabani R, Kinova E, et al. Global longitudinal strain as a marker for systolic function in patients with pheochromocytomas. Endocr Relat Cancer, 2020, 27(10): 561-570.
26. Cuspidi C, Gherbesi E, Faggiano A, et al. Targeting left ventricular mechanics in patients with pheochromocytoma/paraganglioma: an updated meta-analysis. Am J Hypertens, 2023, 36(6): 333-340.
27. Buitenwerf E, Osinga TE, Timmers HJLM, et al. Efficacy of α-blockers on hemodynamic control during pheochromocytoma resection: a randomized controlled trial. J Clin Endocrinol Metab, 2020, 105(7): 2381-2391.
28. Gruber LM, Jasim S, Ducharme-Smith A, et al. The role for metyrosine in the treatment of patients with pheochromocytoma and paraganglioma. J Clin Endocrinol Metab, 2021, 106(6): e2393-e2401.
29. Ommen SR, Semsarian C. Hypertrophic cardiomyopathy: a practical approach to guideline directed management. Lancet, 2021, 398(10316): 2102-2108.
30. Yu M, Du B, Yao S, et al. Von Hippel-Lindau syndrome with a rare complication of dilated cardiomyopathy: a case report. BMC Cardiovasc Disord, 2022, 22(1): 489.
31. Wang FZ, Wei WB, Li X, et al. The cardioprotective effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin in rats with isoproterenol-induced cardiomyopathy. Am J Transl Res, 2021, 13(9): 10950-10961.
32. Fagundes GFC, Almeida MQ. Perioperative management of pheochromocytomas and sympathetic paragangliomas. J Endocr Soc, 2022, 6(2): bvac004.
33. Casey RT, Challis BG, Pitfield D, et al. Management of an acute catecholamine-induced cardiomyopathy and circulatory collapse: a multidisciplinary approach. Endocrinol Diabetes Metab Case Rep, 2017, 2017: 17-0122.
34. Dominedò C, D’Avino E, Martinotti A, et al. A rare pheochromocytoma complicated by cardiogenic shock and posterior reversible encephalopathy syndrome: case report. Eur Heart J Case Rep, 2021, 5(2): ytaa513.
35. Geller BJ, Sinha SS, Kapur NK, et al. Escalating and de-escalating temporary mechanical circulatory support in cardiogenic shock: a scientific statement from the American Heart Association. Circulation, 2022, 146(6): e50-e68.
36. Matteucci M, Kowalewski M, Fina D, et al. Extracorporeal life support for phaeochromocytoma-induced cardiogenic shock: a systematic review. Perfusion, 2020, 35(Suppl 1): 20-28.
37. Nakamura M, Imamura T, Fukui T, et al. Successful management of pheochromocytoma crisis with cardiogenic shock by percutaneous left ventricular assist device. J Cardiovasc Dev Dis, 2022, 9(3): 71.
38. Albulushi A, Zolty R, Lowes B, et al. Perioperative management of pheochromocytoma resection in a patient with a continuous flow left ventricular assist device. J Saudi Heart Assoc, 2020, 32(2): 233-235.
39. Zelinka T, Petrák O, Turková H, et al. High incidence of cardiovascular complications in pheochromocytoma. Horm Metab Res, 2012, 44(5): 379-384.
40. Batisse-Lignier M, Pereira B, Motreff P, et al. Acute and chronic pheochromocytoma-induced cardiomyopathies: different prognoses?: a systematic analytical review. Medicine (Baltimore), 2015, 94(50): e2198.
41. Giavarini A, Chedid A, Bobrie G, et al. Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma. Heart, 2013, 99(19): 1438-1444.

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Progress in the diagnosis and treatment of catecholamine-induced cardiomyopathy in pheochromocytoma/paraganglioma

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