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Archives of cardiovascular diseases
Volume 105, n° 6-7
pages 396-397 (juin 2012)
Doi : 10.1016/j.acvd.2011.05.011
Received : 20 April 2011 ;  accepted : 9 May 2011
Inverted-Takotsubo cardiomyopathy secondary to adrenal mass
Cardiomyopathie de Tako-Tsubo inversée secondaire à une masse surrénalienne
 

Ji-Yoon Park, Soo-Joong Kim
Department of Cardiology, College of Medicine, Kyung Hee University, 1 Hoigi-Dong, Dongdaemoon-Gu, Seoul, 130-702, Republic of Korea 

Corresponding author. Fax: +82 2 958 8160.

Keywords : Pheochromocytoma, Takotsubo, Cardiomyopathy

Mots clés : Syndrome de Takotsubo, Fibrillation ventriculaire, Anesthésie générale, Scanner cardiaque, IRM cardiaque


A 28-year-old woman complained of chest discomfort. Her blood pressure was 120/80mmHg and heart rate 110/min. She had elevated cardiac enzymes with troponin I of 13.0ng/mL, creatinine kinase 819U/L, creatinine kinase–MB 99U/L. ECG showed significant ST depression in V4-6. Glycosuria was found and her fasting blood glucose was 199mg/dL. Cardiac CT angiography revealed normal coronary artery (Figure 1A). Echocardiography showed hypokinesis of mid to basal segments of left ventricle (LV) with preservation of apex showing inverted-Takotsubo pattern (Figure 1B, left sided: diastole, right sided: systole). LV ejection fraction (EF) was 25%. Cardiac magnetic resonance imaging showed dilated cardiomyopathy with hypokinesis of basal and mid-ventricle and sparing of apex (Figure 1C left sided: diastole, right sided: systole). There was mild high signal intensity in T2W black blood image (Figure 1D) and no late gadolinium enhancement (Figure 1E). Based on tachycardia, hyperglycemia, glycosuria and abnormal LV motion, we checked abdomen CT under suspicion of pheochromocytoma-induced cardiomyopathy, revealing a 6.4cm×6cm sized right adrenal mass with prominent vascularity (Figure 1F). Plasma test found markedly elevated norepinephrine of 13.80 (0.07–0.4ng/mL) and epinephrine 0.71 (0.04–0.2ng/mL). 24-hr urine collection demonstrated the elevation of norepinephrine (1618.0μg, 15–80), epinephrine (137.0μg, 1.2–20), metanephrine (8.2 μg, 0.2–1.2), and vanillylmandeic acid (33.7mg, 1–5).



Figure 1


Figure 1. 

Cardiac CT angiography (A) revealed normal coronary artery, and echocardiography (B) and cardiac MRI (C, D, E) showed dilated cardiomyopathy with hypokinesis of mid to basal segments of left ventricle and preservation of apex showing inverted-Takotsubo pattern. Abdomen CT (F) revealed a 6.4cm×6cm sized right adrenal mass with prominent vascularity.

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The right adrenal mass was visualized by scintigraphy with 131-metaiodobenzilguanidine (MIBG). Follow up echocardiography after 2 days with conservative management showed improving LV wall motion with EF of 36.7%. Surgical excision of adrenal mass confirmed pheochromocytoma and made LV wall motion normalized with LVEF of 65%. Final diagnosis was pheochromocytoma-induced cardiomyopathy of inverted Takotsubo pattern (Appendix A).

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.


Appendix A. Supplementary data

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