Cardiovascular disorders in hypertensive pheochromocytoma patients

Objective: To study frequency and peculiarities of cardiovascular disorders in hypertensive pheochromocytoma (pheo) patients (pts). Design and methods: 250 hypertensive pheo pts (112 males and 138 females, mean age 41.7 11.8 y) were retrospectively studied. Tumors were located in adrenals in 232 (right 120, left 92, both 20) and were extraadrenal in 18 pts. 38 pts had recurrent pheo. All pts were operated and pheo was verified as benign (n1⁄4108), malignant (n1⁄4139) and borderline (n1⁄43) by histology. Tumor’s weight varied from 15 to 900 g and size from 1.5 to 12 cm. Results: In 41 of 250 pts (16.4%) hypertension was malignant (M), in 141 pts including 3M (56.4%, 2.1 %M) paroxysmal, in 70 pts including 31M (28.0%, 44.3 %M) sustain with crises, in 39 pts including 7M (15.6%, 17.9 %M) sustain without crises. Pulmonary edema was diagnosed in 8 of 250 pts (3.2%). Renal arteriography (n1⁄440) revealed renal artery stenosis (RAS) in 3 cases (7.5%), in 2 of them RAS was reversible. According to ECHOCG (n1⁄440) cardiac valve prolapse was registered in 19 pts (47.%), left ventricular hypertrophy 16 pts (40.0%). Myocardial infarction (MI) like changes were seen in 12 of 250 pts (4.8%), and postinfarction cardiosclerosis in 2 pts with recurrent pheo (0.8%). ECG 12 was normal in 20 pts (8%); different arrhythmias, conduction disorders were registered in 66 pts (26.4%). Holter ECG-monitoring (n1⁄440) revealed different arrhythmias in 19 pts (47.5%), dangerous ventricular arrhythmias (VA) in 7 pts (17.5%) and life-threatening VA in 2 pts (5%). Transient stroke was diagnosed in 14 (5.6%), both severe stroke and retinal detachment in 4 (1.6% each) of 250 pts. Conclusions: MI-like changes and reversible RAS were most likely caused by coronary or renal artery spasm, and were resolved after therapy with alpha-blockers and pheo removal. MI related to coronary atherosclerosis was observed in patients with recurrent pheo. Stroke, pulmonary edema and retinal detachment were related to high BP during hypertensive crises. Various arrhythmias were registered with Holter ECG-monitoring in 47.5% pheo pts, but dangerous and life-threatening ventricular arrhythmias in 17.5% and 5% respectively. Cardiac valve prolapse was revealed in nearly half of the pheo pts, most frequently mitral valve prolapse was seen. Most complications of high BP took place in pheo pts with malignant hypertension. In most cases (44.3%) malignant hypertension was observed in patients with sustain hypertension with crises.