title: Takotsubo-like cardiomyopathy in pheochromocytoma.
abstract: BACKGROUND
  Takotsubo Cardiomyopathy (TTC) is commonly triggered by acute illness, physical or emotional stress and has been associated with elevated catecholamine levels. TTC has also been associated with pheochromocytoma (TTC-pheo).
  
  
  METHODS
  We performed a computer assisted search of the electronic databases Medline, Scopus and Google Scholar from 1965 to January 2011. All case reports with reported TTC-pheo were selected and compared to a recent review by Gianni et al. which examined primary TTC (TTC-primary).
  
  
  METHODS
  Data analysis was performed using SPSS version 18. Chi-square test of Fisher's exact test was used as appropriate to compare categorical data.
  
  
  RESULTS
  38 cases of TTC-pheo were retrieved from literature and compared to 254 cases of TTC-p. Chest pain was the most common presentation in both groups. The TTC-pheo patients were on average 18 years younger than patients with TTC-p (p<0.01). Only a minority of TTC-pheo patients presented with classical features of pheochromocytoma including hypertension (52.6%), headache (28.9%), palpitations (31.6 %), and diaphoresis (26.3%). In TTC-pheo complications rates were higher compared to TTC-p, including cardiogenic shock (34.2% vs. 4.2%, p<0.01) and heart failure (46.7% vs. 17.7%, p<0.01). Antecedent stressors were less common in TTC-pheo. About one-third of TTC-pheo patients presented with the inverted pattern, which compared to the apical pattern, was associated with higher complication rates, including, cardiogenic shock, heart failure, acute renal failure and arrhythmias.
  
  
  CONCLUSIONS
  Although rare, pheochromocytoma should be considered in the differential diagnosis of TTC especially in younger patients presenting without antecedent stressors and a high complication rate. The similarities in the clinical features and outcomes in patients with TTC-p and TTC-pheo point to a similar underlying cardiac pathophysiologic process at the time of the acute presentation.
authors.affiliation: Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10019, United States.
authors.forename: Vikram
authors.initials: V
authors.lastname: Agarwal
authors.forename: Gunjan
authors.initials: G
authors.lastname: Kant
authors.forename: Nidhi
authors.initials: N
authors.lastname: Hans
authors.forename: Franz H
authors.initials: FH
authors.lastname: Messerli
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D000818:Animals; D002637:Chest Pain / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D016208:Databases, Factual; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods; D006801:Humans; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*