A clinical study of cardiovascular manifestations of 78 pheochromocytoma/paraganglioma patients

Objective To explore the prevalence, manifestations, clinical outcomes and etiology of cardiovascular abnormalities among pheochromocytoma/paraganglioma (PH/PGL) patients. Methods Seventy-eight PH/PGL patients receiving medical attention at Peking Union Medical College Hospital from October 2010 to April 2013 were included in the study. Clinical symptoms, blood pressure, heart rate, biomarkers of myocardial injury and heart failure, electrocardiogram, echocardiography, and levels of 24-hour urinary catecholamine of the patients were recorded and analyzed. Results (1) Of the 78 patients, 66(84.6%) were hypertensive, 3(3.8%) experienced hypotensive episodes, 45(57.7%) had histories indicative of cardiac injuries, including 3(3.8%) with acute left-sided heart failure episodes, 6(7.7%) with concurrent evolving cardiac enzyme elevation and alteration of ECG ST-T segment, 6(7.7%) with decreased left ventricular ejection fraction(LVEF), 5 of which restored during follow-up, 30(38.5%) with arrhythmias, 25(32.1%) with left ventricular hypertrophy. (2) Among hypertensive PH/PGL patients, levels of 24-hour urinary norepinephrine [435(61-766)μg/24 h vs. 110(35-242)μg/24h, U=320, P<0.01] and epinephrine[3.51(3.01-4.53)μg/24 h vs. 2.88(2.32-3.89)μg/24h, U=337, P=0.02] were significantly higher in LV hypertrophy group than in normal geometry group, while the duration, manifestation (sustained vs. paroxysmal) and degree of blood pressure elevation did not differ between the two groups. Conclusions PH/PGL can cause multiple cardiovascular alterations. Decreased LVEF, often reversible, occurs occasionally. Key words: Pheochromocytoma; Cardiovascular manifestation; Hypertension; Cardiomyopathies