IMR Press / RCM / Volume 22 / Issue 4 / DOI: 10.31083/j.rcm2204130
Open Access Review
Catecholamine-induced cardiomyopathy: an endocrinologist’s perspective
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1 Department of Medicine, University of Birmingham Medical School, B15 2TH Birmingham, UK
2 Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, PR2 9HT Preston, UK
3 Faculty of Science, Manchester Metropolitan University, M15 6BH Manchester, UK
4 Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL Manchester, UK
5 Department of Endocrinology and Metabolism, Pilgrim Hospital, PE21 9QS Boston, UK
*Correspondence: drpappachan@yahoo.co.in (Joseph M Pappachan)
Academic Editor: Ichiro Wakabayashi
Rev. Cardiovasc. Med. 2021, 22(4), 1215–1228; https://doi.org/10.31083/j.rcm2204130
Submitted: 29 July 2021 | Revised: 27 August 2021 | Accepted: 22 September 2021 | Published: 22 December 2021
(This article belongs to the Special Issue Risk Factors for Cardiovascular Diseases)
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).
Abstract

Although many endocrine diseases can be associated with acquired cardiomyopathy and heart failure, conditions except hypothyroidism, hyperthyroidism, phaeochromocytoma-paraganglioma (PPGL), and primary hyperaldosteronism are rare. PPGL is a rare catecholamine-secreting neuroendocrine tumour arising from the adrenal gland in 80–85% or extra-adrenal chromaffin cells of the autonomic neural ganglia in the remainder. The annual incidence of PPGL is 3–8 cases per million per year in the general population. Catecholamine-induced cardiomyopathy (CICMP) has got a prevalence of 8–11% among patients with PPGL. Hypertension, either sustained or episodic, is present in the vast majority (95%) of PPGL patients. However, among patients with CICMP, hypertension is present only in 65% of cases and the classical triad of paroxysmal headache, sweating, and palpitation is present only in 4%. Based on the cardiac remodelling in response to endogenous catecholamine excess, PPGL patients might present with one of the three CICMPs, including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), or Takotsubo cardiomyopathy (TCM). Regardless of the subtypes, all CICMPs have many features in common — a dramatic clinical presentation, reversible cardiomyopathy, similar repolarisation electrocardiography changes, mild-moderate cardiac biomarker elevation, and normal coronary arteries on coronary angiography. CICMP should be suspected in patients with non-ischaemic, non-valvular forms of cardiomyopathy, even in those without definite features of catecholamine excess. PPGL associated TCM should be suspected in all acute coronary syndrome (ACS) patients exhibiting pronounced blood pressure variability with no culprit lesions on coronary angiography. This article will provide a review of the various CICMPs, their pathophysiology, clinical features, and the management options.

Keywords
Catecholamine-induced cardiomyopathy
Phaeochromocytoma
Heart failure
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