Pheochromocytoma in Menopause Causing Catecholamine-Induced Cardiomyopathy: A Case Report

Vivian Zhang BA^1, , Emma Barry BA¹ and Lyn Dea DO²

¹University of Maryland School of Medicine, Baltimore, MD, USA, 21201

²Maryland Primary Care Physicians, Annapolis, MD, USA, 21401

Cite this paper:
Vivian Zhang BA, Emma Barry BA and Lyn Dea DO. Pheochromocytoma in Menopause Causing Catecholamine-Induced Cardiomyopathy: A Case Report. American Journal of Medical Case Reports. 2024; 12(6):87-90. doi: 10.12691/ajmcr-12-6-2

Abstract

Diagnosis of pheochromocytoma, a rare, largely-incidentally found tumor of the adrenal glands, is typically challenging due to its frequently variable, nonspecific, and atypical presentations as it can mimic many other diagnoses, notably menopause. This study details a case of a 47-year-old female who primarily presented with flushing and insidious weight loss; further studies also revealed a new hyperglycemia. Initially thought to be menopausal symptoms, she then returned months later with chest pain and dyspnea and underwent cardiac work-up for a diagnosis of myopericarditis and eventually cardiomyopathy. After being hospitalized for pneumonia, her pheochromocytoma was finally incidentally discovered on abdominal CT. Pheochromocytomas should be considered in the differential diagnoses of flushing in menopause-age women and can occur with normotensive, atypical presentations, particularly patients with more concerning features such as weight loss. Furthermore, pheochromocytomas can cause long-lasting cardiac damage, and should be acknowledged as a possible cause of cardiomyopathy.

Keywords:
case report pheochromocytoma menopause myocarditis catecholamine-induced cardiomyopathy

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References:

[1]	Lenders JWM, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SKG, Murad MH, et al. Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014 Jun 1; 99(6): 1915–42.
[2]	Kiriakopoulos A, Giannakis P, Menenakos E. Pheochromocytoma: a changing perspective and current concepts. Ther Adv Endocrinol Metab. 2023 Jan; 4: 20420188231207544.
[3]	Falhammar H, Kjellman M, Calissendorff J. Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center. Endocr Connect. 2018 Jan; 7(1): 186–92.
[4]	Soltani A, Pourian M, Davani BM. Does this patient have Pheochromocytoma? a systematic review of clinical signs and symptoms. J Diabetes Metab Disord. 2016 Dec; 15(1): 6.
[5]	Zhang R, Gupta D, Albert SG. Pheochromocytoma as a reversible cause of cardiomyopathy: Analysis and review of the literature. Int J Cardiol. 2017 Dec; 249: 319–23.
[6]	Yu R, Nissen NN, Bannykh SI. Cardiac Complications as Initial Manifestation of Pheochromocytoma: Frequency, Outcome, and Predictors. Endocr Pract. 2012 Jul; 18(4): 483–92.
[7]	Cho T, Tanimura A, Saito Y. CATECHOLAMINE‐INDUCED CARDIOPATHY ACCOMPANIED WITH PHEOCHROMOCYTOMA. Acta Pathol Jpn. 1987 Jan; 37(1): 123–32.
[8]	Kaneto H, Kamei S, Tatsumi F, Shimoda M, Kimura T, Nakanishi S, et al. Case Report: Malignant Pheochromocytoma Without Hypertension Accompanied by Increment of Serum VEGF Level and Catecholamine Cardiomyopathy. Front Endocrinol. 2021 Jun 25; 12: 688536.
[9]	Khattak S, Sim I, Dancy L, Whitelaw B, Sado D. Phaeochromocytoma found on cardiovascular magnetic resonance in a patient presenting with acute myocarditis: an unusual association. BMJ Case Rep. 2018 Jun 8; 2018: bcr2017222621, bcr-2017–222621.
[10]	Wang AR, Dean SA, Grebe SK, Hood IC. Fatal Catecholamine-Induced Cardiotoxicity Associated with Pheochromocytoma: Report of a Postpartum Case and Review of the Literature. Acad Forensic Pathol. 2016 Jun; 6(2): 315–24.
[11]	Davide Muratori, Patrizia Pedrotti, Matteo Baroni, Armando Belloni, Giuseppina Quattrocchi, Angela Milazzo, et al. Miocardite indotta da catecolamine in feocromocitoma. G Ital Cardiol [Internet]. 2017 Feb 1 [cited 2024 Jan 22]; (2017Febbraio).
[12]	de Miguel V, Arias A, Paissan A, de Arenaza DP, Pietrani M, Jurado A, et al. Catecholamine-induced myocarditis in pheochromocytoma. Circulation. 2014 Mar 25; 129(12): 1348–9.
[13]	Ferreira VM, Marcelino M, Piechnik SK, Marini C, Karamitsos TD, Ntusi NAB, et al. Pheochromocytoma Is Characterized by Catecholamine-Mediated Myocarditis, Focal and Diffuse Myocardial Fibrosis, and Myocardial Dysfunction. J Am Coll Cardiol. 2016 May; 67(20): 2364–74.
[14]	Wittstein IS, Thiemann DR, Lima JAC, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress. N Engl J Med. 2005 Feb 10; 352(6): 539–48.
[15]	Singal PK, Kapur N, Dhillon KS, Beamish RE, Dhalla NS. Role of free radicals in catecholamine-induced cardiomyopathy. Can J Physiol Pharmacol. 1982 Nov 1; 60(11): 1390–7.
[16]	Santos DRPD, Barbisan CC, Marcellini C, Santos RMVRD. Pheochromocytoma and pregnancy: A case report and review. J Bras Nefrol [Internet]. 2015 [cited 2024 Mar 19]; 37(4). Available from: http:// www.scielo.br/ scielo.php? script= sci_arttext& pid=S0101-28002015000400496.
[17]	Chen HF, Su JY, Tong JR, Chen Y, Huang LL, Deng L. Pheochromocytoma in pregnancy: a case report. Eur Rev Med Pharmacol Sci. 2023 Jun; 27(12): 5700–5.
[18]	Palomba G, Dinuzzi VP, Palumbo M, Amendola A, Errico C, Basile R, et al. Management of pheochromocytoma during pregnancy from diagnosis to laparoscopic adrenalectomy. A case report and review of literature. Ann Ital Chir. 2021; 92: 254–9.
[19]	Wyskida M, Wyskida K, Maruniak-Chudek I, Sikora J, Chudek J. Pheochromocytoma in pregnancy. Postępy Hig Med Dośw. 2014 Jun 9; 68: 749–53.
[20]	Huguet I, Grossman A. MANAGEMENT OF ENDOCRINE DISEASE: Flushing: current concepts. Eur J Endocrinol. 2017 Nov; 177(5): R219–29.
[21]	Izikson L, English JC, Zirwas MJ. The flushing patient: Differential diagnosis, workup, and treatment. J Am Acad Dermatol. 2006 Aug; 55(2): 193–208.
[22]	Mohyi D, Tabassi K, Simon J. Differential diagnosis of hot flashes. Maturitas. 1997 Jul 1; 27(3): 203–14.