title: Cardiac complications as initial manifestation of pheochromocytoma: frequency, outcome, and predictors.
abstract: OBJECTIVE
  To examine the frequency, outcome, and clinical predictors of cardiac complications as the initial manifestation of pheochromocytoma.
  
  
  METHODS
  The medical records of all 76 patients with pheochromocytoma or functional paraganglioma treated at Cedars-Sinai Medical Center, Los Angeles, California, from 1995 to 2011 were reviewed. The patients initially presenting with cardiac complications were identified, and their clinical, laboratory, and imaging characteristics were compared with those of the patients presenting with other complaints, especially hypertension and adrenal mass.
  
  
  RESULTS
  Of the 76 patients, 9 (12%) presented with the following: 2 with acute heart failure, 1 with left ventricular thrombus, 3 with myocardial infarction, and 3 with severe arrhythmia. Failure to diagnose pheochromocytoma resulted in unnecessary invasive interventions in 2 patients. Recovery of cardiac function was excellent after resection of the tumor in all patients. In comparison with the 67 patients presenting with other complaints, the 9 with cardiac complications had similar demographics and cardiac risk factors but harbored larger tumors (6.7 ± 0.8 cm versus 4.4 ± 0.3 cm; P = .015) and exhibited higher biochemical marker levels (23.9 ± 9.0-fold versus 11.3 ± 2.4-fold; P = .082), longer corrected QT interval (473 ± 8 ms versus 443 ± 6 ms; P = .015), and lower ejection fraction (43% ± 8% versus 66% ± 2%; P = .002).
  
  
  CONCLUSIONS
  In this study, 12% of patients with pheochromocytoma initially presented with cardiac complications. Patients with large tumors and high levels of biochemical markers were more likely to develop cardiac injury. Our results confirm that the presence of pheochromocytoma should be ruled out in patients with cardiac diseases and features suggesting pheochromocytoma so that unnecessary interventions can be avoided and cardiac recovery can be achieved.
authors.affiliation: Division of Endocrinology and Carcinoid and Neuroendocrine Tumor Center, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. run.yu@cshs.org
authors.forename: Run
authors.initials: R
authors.lastname: Yu
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Nissen
authors.forename: Serguei I
authors.initials: SI
authors.lastname: Bannykh
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D000328:Adult; D003663:Decision Trees; D057210:Delayed Diagnosis / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D015994:Incidence; D008133:Long QT Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010235:Paraganglioma / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D010673:Pheochromocytoma / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D012720:Severity of Illness Index; D013318:Stroke Volume; D047368:Tumor Burden