Review Article

Pheochromocytoma and Myocardial Infarction

Authors: Anuj Garg, MBBS, MD, Peter F. Banitt, MD

Abstract

Pheochromocytomas are rare chromaffin cell tumors, 90% of which arise from the adrenal glands. Pheochromocytomas presenting with true myocardial infarction are even more rare. We report a 76-year-old man who had a previously undiagnosed pheochromocytoma, and presented with the uncommon complication of myocardial infarction. Our high-risk patient was managed with the combination of simultaneous coronary artery bypass grafting and adrenalectomy.


Key Points


* The best biochemical marker to diagnose pheochromocytoma is plasma free metanephrine.


* Metyrosine decreases catecholamine production by 50 to 80%, and can be used with alpha-blocking agents to decrease intraoperative complications due to hormonal surges.


* Adrenalectomy combined with coronary artery bypass graft may be considered a good option for managing pheochromocytoma and coronary artery disease together.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Baillargeon JP, Pek B, Teijeira J, et al. Combined surgery for coronary artery disease and pheochromocytoma. Can J Anaesth 2000;47:647–652.
 
2.Lenders JW, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma: which test is best?. J Am Med Assoc 2002;287:1427–1424.
 
3.Kudva YC, Sawka AM, Young WF. The laboratory diagnosis of adrenal pheochromocytoma: the Mayo Clinic experience. J Clin Endocrinol Metab 2003;88:4533–4539.
 
4.Steinsapir J, Carr AA, Prisant LM, et al. Metyrosine and pheochromocytoma. Arch Intern Med1997;157:901–906.
 
5.Nielson DH, Tomasello DN, Brennan EJ, et al. Concomitant coronary artery bypass grafting and adrenalectomy for pheochromocytoma. J Cardiac Surg 1995;10:179–183.
 
6.Seah PW, Costa R, and Wolfenden H. Combined coronary artery bypass grafting and excision of adrenal pheochromocytoma. J Thorac Cardiovasc Surg 1995;110:559–560
 
7.Balabaud-Pichon V, Bopp P, Levy F, et al. Excision of adrenal pheochromocytoma and coronary artery bypass graft surgery with cardiopulmonary bypass. J Cardiothoracic Vascular Anesth2002;16:344–346.
 
8.Walther MM, Keiser HR, and Linehan WM. Pheochromocytoma: evaluation, diagnosis, and treatment.World J Urology 1999;17:35–39.
 
9.Eisenhofer G, Huynh T, Hiroi M, et al. Understanding catecholamine metabolism as a guide to the biochemical diagnosis of pheochromocytoma. Rev Endocrine & Metabol Disord 2001;2:297–311.
 
10.Manger W, Gifford R. Pheochromocytoma. J Clin Hypertens 2002;4:62–72.
 
11.Sawka AM, Jaeschke R, Singh RJ, et al. A comparison of biochemical tests for pheochromocytoma: measurement of fractionated plasma metanephrines compared with the combination of 24-hour urinary metanephrines and catecholamines. J Clin Endocrinol Metab 2003;88:553–558.