Cardiovascular manifestations of pheochromocytoma

Pheochromocytomas are rare tumors that originate in chromaffin tissue and p roduce their distant variant effects by secretion of catecholamines, tendin g to mislead the emergency physicians to a wrong diagnosis. Therefore, we a nalyze the clinical cardiovascular manifestations in patients with pheochro mocytoma to improve the diagnostic ability of the emergency physicians. All patients presenting to the Chang Gung Memorial Hospital between January 19 93 and December 1997 with a final diagnosis of pheochromocytoma had their c harts reviewed, The data of 25 patients including age, sex, adrenergic stim ulation presentations, electrocardiographic changes, location of the tumor, and complications were analyzed, Hypertension was the most important major manifestation and fluctuation of blood pressure drew our attention to the possibility of pheochromocytoma. Six patients had abnormal electrocardiogra phic ST-T segment changes. Five of them had chest pain which prompted them to undergo coronary angiography before surgery, because acute coronary synd rome (unstable angina and acute myocardial infarction) was suspected initia lly. However, all of them turned out to have normal coronary arteries. Figh t-sided pheochromocytoma was found in three of these five patients. We shou ld maintain high index of suspicion for pheochromocytoma in patients presen ting with chest pain, fluctuating blood pressure, and ischemic electrocardi ogram (ECG) changes despite any typical isoenzyme changes, Pheochromocytoma should also be included in the differential diagnosis of acute coronary sy ndrome because acute catecholamine secretion may induce chest pain and abno rmal ECG changes mimicking an ischemic episode. The right-sided pheochromoc ytoma may present more striking electrocardiographic abnormalities and clin ical manifestations. Copyright (C) 2000 by W.B. Saunders Company.