{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:37Z","timestamp":1784557057709,"version":"3.55.0"},"reference-count":52,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2019,4,16]],"date-time":"2019-04-16T00:00:00Z","timestamp":1555372800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,4,16]]},"abstract":"Summary<\/jats:title>\n \n Pheochromocytoma\/paraganglioma (PPGL) are neuroendocrine tumors that can secrete catecholamines. The authors describe a challenging case who presented as stress cardiomyopathy and myocardial infarction (MI). A 76-year-old man, with a medical history of Parkinson\u2019s disease, type 2 diabetes mellitus, hypertension, dyslipidaemia and a previous inferior MI in 2001, presented to the emergency department due to chest pain, headaches and vomiting. He also reported worsening blood glucose levels and increasing constipation over the preceding weeks. BP was 185\/89\u2009mmHg (no other relevant findings). EKG had ST segment depression in leads V2-V6, T troponin was 600\u2009ng\/L (<14) and the echocardiogram showed left ventricular hypokinesia with mildly compromised systolic function. Nevertheless, he rapidly progressed to severe biventricular dysfunction. Coronary angiogram showed a 90% anterior descendent coronary artery occlusion (already present in 2001), which was treated with angioplasty\/stenting. In the following days, a very labile BP profile and unexplained sinus tachycardia episodes were observed. Because of sustained severe constipation, the patient underwent an abdominal CT that revealed a retroperitoneal, heterogeneous, hypervascular mass on the right (62\u2009\u00d7\u200935\u2009mm), most likely a paraganglioma. Urinary metanephrines were increased several fold.\n 68<\/jats:sup>\n Ga-DOTANOC PET-CT scan showed increased uptake in the abdominal mass (no evidence of disease elsewhere). He was started on a calcium-channel blocker and alpha blockade and underwent surgery with no major complications. Eight months after surgery, the patient has no evidence of disease. Genetic testing was negative for known germline mutations. This was a challenging diagnosis, but it was essential for adequate cardiovascular stabilization and to reduce further morbidity.\n <\/jats:p>\n \n Learning points:<\/jats:title>\n \n \n PPGL frequently produces catecholamines and can manifest with several cardiovascular syndromes, including stress cardiomyopathy and myocardial infarction.<\/jats:p>\n <\/jats:list-item>\n \n Even in the presence of coronary artery disease (CAD), PPGL should be suspected if signs or symptoms attributed to catecholamine excess are present (in this case, high blood pressure, worsening hyperglycaemia and constipation).<\/jats:p>\n <\/jats:list-item>\n \n Establishing the correct diagnosis is important for adequate treatment choice.<\/jats:p>\n <\/jats:list-item>\n \n Inodilators and mechanical support might be preferable options (if available) for cardiovascular stabilization prior to alpha blockade and surgery.<\/jats:p>\n <\/jats:list-item>\n \n Laboratory interference should be suspected irrespective of metanephrine levels, especially in the context of treated Parkinson\u2019s disease.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-19-0017","type":"journal-article","created":{"date-parts":[[2019,4,16]],"date-time":"2019-04-16T06:52:42Z","timestamp":1555397562000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":8,"title":["Paraganglioma presenting as stress cardiomyopathy: case report and literature review"],"prefix":"10.1530","volume":"2019","author":[{"given":"Ana Gon\u00e7alves","family":"Ferreira","sequence":"first","affiliation":[{"name":"1Endocrinology and Diabetes Department, Garcia de Orta Hospital, Almada, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago","family":"Nunes da Silva","sequence":"additional","affiliation":[{"name":"2Endocrinology Department, Portuguese Institute of Oncology Francisco Gentil, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Alegria","sequence":"additional","affiliation":[{"name":"3Cardiology Department, Garcia de Orta Hospital, Almada, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Carlos","family":"Cordeiro","sequence":"additional","affiliation":[{"name":"1Endocrinology and Diabetes Department, Garcia de Orta Hospital, Almada, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Portugal","sequence":"additional","affiliation":[{"name":"1Endocrinology and Diabetes Department, Garcia de Orta Hospital, Almada, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref141","doi-asserted-by":"publisher","first-page":"201331","DOI":"10.1111\/1755-5922.12047","article-title":"BiaseMBrunettiND Safety and feasibility of Levosimendan Administration in Takotsubo a case series https org","author":"BiaseLDi","journal-title":"Cardiovascular Therapeutics"},{"key":"ref431","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1093\/eurheartj\/ehy077","article-title":"International expert consensus document on takotsubo syndrome (Part II): diagnostic workup, outcome, and management","volume":"39","year":"2018","journal-title":"European Heart Journal"},{"key":"ref321","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.4158\/EP171930.OR","article-title":"Takotsubo-like cardiomyopathy in a large cohort of patients With pheochromocytoma and paraganglioma","volume":"23","year":"2017","journal-title":"Endocrine Practice"},{"key":"ref191","article-title":"An unexpected post - partum fulminant heart failure of https org","volume":"47","journal-title":"International Journal Cardiology"},{"key":"ref101","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1258\/000456307780945705","article-title":"Parkinson\u2019s disease: the effect of L-dopa therapy on urinary free catecholamines and metabolites","volume":"44","year":"2007","journal-title":"Annals of Clinical Biochemistry"},{"key":"ref271","doi-asserted-by":"crossref","first-page":"e2198","DOI":"10.1097\/MD.0000000000002198","article-title":"Acute and chronic pheochromocytoma-induced cardiomyopathies: different prognoses? 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after elective nonrelated surgical procedures","volume":"2013","year":"2013","journal-title":"Case Reports in Anesthesiology"},{"key":"ref291","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1055\/s-0032-1306294","article-title":"High incidence of cardiovascular complications in pheochromocytoma","volume":"44","year":"2012","journal-title":"Hormone and Metabolic Research"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"76","DOI":"10.4250\/jcu.2011.19.2.76","article-title":"Prevalence and patterns of left ventricular dysfunction in patients with pheochromocytoma","volume":"19","year":"2011","journal-title":"Journal of Cardiovascular Ultrasound"},{"key":"ref371","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/cen.12324","article-title":"Phaeochromocytoma crisis","volume":"80","year":"2014","journal-title":"Clinical Endocrinology"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1055\/s-0032-1306294","article-title":"High 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