Catecholamine-induced cardiomyopathy in a patient with pheochromocytoma and polycystic kidney and liver disease: a case report

摘要

Background Clinical manifestations of pheochromocytoma (PCC) frequently are not specific and can be attributed to other pathologies. The most dreaded manifestation is catecholamine-induced cardiomyopathy. A prompt diagnosis, sometimes extremely problematic due to associated conditions of the patient, is essential for clinical outcomes, because early resection of PCC may prevent progression to irreversible cardiac remodelling. Case summary We present a case of 47-year-old woman with suspected acute coronary syndrome but intact coronary vessels. Electrocardiogram examination showed ST depression suggestive for coronary ischaemia. Echocardiography revealed reduced ejection fraction of left ventricle and global hypokinesis. Abdominal ultrasound examination determined multiple cysts in liver and both kidneys. The patient had unclear transient states of sudden sweating, pale skin, nausea, and vomiting accompanied by hypertensive crisis. Fractioned urinary metanephrines were considerably increased. Contrasted computed tomography of abdominal cavity and pelvis revealed in both liver lobes many cysts; both kidneys showed multiple cysts too; in the right adrenal gland was detected a filling defect. Computed tomography findings have established diagnosis of adrenal PCC of right gland associated with liver and kidney polycystic disease. Discussion Phechromocytoma, with primary manifestation as catecholamine-induced cardiomyopathy, in patient with polycystic kidney and liver disease could represent a really challenging diagnosis. Clinical manifestations of PCC frequently are not specific and can be explained by associated pathologies. This is the second case of adrenalectomy due to PCC associated with polycystic kidney and liver disease reported in the medical literature. Pheochromocytoma , Catecholamine-induced cardiomyopathy , Autosomal dominant polycystic kidney disease , Liver cysts , Case report Learning points Pheochromocytoma (PCC) should be suspected in patients who present with cardiomyopathy and no concomitant valvular or ischaemic pathology even when clinical manifestations are not typical for catecholamine excess. Prompt diagnosis of PCC in patients with catecholamine-induced cardiomyopathy is of great importance due to potential reversibility of cardiac remodelling. Hypertension and hypertensive crises in a patient with polycystic kidney and liver disease can also be explained by concomitant presence of PCC.