RT Journal Article
SR Electronic
T1 Lesson of the month 2: Catecholamine-induced cardiomyopathy – pitfalls in diagnosis and medical management
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 201
OP 203
DO 10.7861/clinmedicine.16-2-201
VO 16
IS 2
A1 Yaasir Mamoojee
A1 Munawar Arham
A1 Wael Elsaify
A1 Sath Nag
YR 2016
UL http://www.rcpjournals.org/content/16/2/201.abstract
AB Cardiomyopathy as the initial presentation of phaeochromocytoma (PCA) is uncommon. Diagnostic work-up and perioperative management may be challenging within this context. We report three cases of PCA presenting with cardiomyopathy to illustrate the pitfalls in diagnosis and management. None of the patients had typical adrenergic symptoms and all three were established on beta-blockers prior to diagnosis. Their fractionated plasma catecholamine levels were elevated and the diagnosis of PCA was confirmed with various imaging modalities and post adrenalectomy. Interpretation of fractionated catecholamine levels in the context of established cardiomyopathy is difficult as cardiac failure of any aetiology generates an adrenergic response. Hence screening all patients with idiopathic cardiomyopathy is likely to generate a high false-positive rate. However, a high index of suspicion should prompt further diagnostic work-up in patients with idiopathic cardiomyopathy for occult PCAs. Peer-reviewed guidelines are required to guide the investigation and management of suspected catecholamine-induced cardiomyopathy.