Tako-tsubo cardiomyopathy as initial presentation of pheocromocytoma. A clinical case.

INTRODUCTION Tako-tsubo cardiomyopathy is a rapidly reversible form of acute heart failure triggered by stressful events that occur more frequently in postmenopausal women. A central role is supposed to be played by catecholamines and the association with pheocromocytoma is rare. CASE PRESENTATION We describe a patient admitted for abdominal pain and suffering of hypertension pharmacologically treated. During hospitalization the patient presented cephalea and precordial pain with nausea and profuse sweating. ECG showed ST elevation and deep negative T wave. Blood tests were moderately elevated. Echo-cardiography reported a left ventricular apex akynesia and hyperkynesia of the base while coronarography was negative. As hypertension persisted the suspicion of pheocromocytoma arose. Urinary and blood catecholamines were mildly elevated and echography and Magnetic Resonance revealed a left adrenal gland mass. The diagnosis of pheocromocytoma was thus confirmed Left laparoscopic adrenalectomy was performed after adequate stabilization and preoperative pharmacological preparation by hydration, a-and f-blockers. Intraoperatively blood pressure was controlled by nitroprussiate, rapid half life beta-blockers (esmolol cloridrate). Post-operative course was uneventful and arterial pressure returned to normal as well as catecholamines values. Patient was discharged on the 5th post-operative day Five months afterwards the patient had normal arterial pressure without anti-hypertensive therapy and symptom free. CONCLUSION The case confirmed that tako-tsubo cardiomyopathy could be the first manifestation of tumors secreting catecholamines and that pheocromocytoma should be considered in patients with hypertension and acute stress-induced cardiomiopathy without evidence of acute coronary disease and with negative coronarography.