Bilateral carotid body paraganglioma resection precipitated Takotsubo cardiomyopathy in a 32-year-old patient, with troponin rising to 1100 ng/mL and subsequent recovery to 50% ejection fraction.
Case Report (n=1)
Catecholamine surges during paraganglioma resection can precipitate Takotsubo cardiomyopathy, emphasizing the importance of perioperative cardiac monitoring.
Objective: Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal chromaffin cells and may lead to excessive catecholamine secretion. Surgical resection, although definitive, carries a risk of significant cardiovascular complications. Takotsubo cardiomyopathy, a stress-induced and reversible cardiac dysfunction, has been reported in association with catecholamine surges but is uncommon in patients undergoing paraganglioma surgery.Design and method: A 32-year-old patient presented to the emergency department with dizziness, syncope, and severe hypertension (blood pressure up to 240/110 mmHg). Past medical history included arterial hypertension and right adrenalectomy for pheochromocytoma; a left adrenal lesion remained. Initial investigations showed sinus tachycardia on ECG, normal complete blood count, biochemistry, and electrolytes. Plasma free metanephrines were elevated. Echocardiography revealed a structurally normal heart. Carotid duplex ultrasonography detected bilateral carotid body tumors. Histopathology confirmed extra-adrenal paraganglioma (chemodectoma). After vascular surgery consultation, staged surgical management was planned: left-sided resection followed by right-sided resection. Results: The first surgery was uneventful. Following the second surgery, the patient developed acute chest pain and dyspnea. ECG demonstrated new negative dynamic changes compared to baseline. Echocardiography revealed apical dyskinesia with reduced ejection fraction. Serial troponin levels rose significantly from 110 ng/mL to 1100 ng/mL. Coronary CT angiography showed no evidence of coronary artery obstruction. Based on clinical, laboratory, and imaging findings, catecholamine-induced Takotsubo cardiomyopathy was diagnosed. The patient received medical management and was discharged in stable condition. During follow-up, left ventricular function improved, with an ejection fraction of 50%. Cardiac MRI demonstrated preserved biventricular function with non-ischemic myocardial changes. Abdominal CT revealed no progression of the left adrenal lesion. Conclusions: This case illustrates a rare but significant cardiovascular complication following paraganglioma surgery. Catecholamine surges can precipitate Takotsubo cardiomyopathy even in the absence of coronary artery disease. Perioperative monitoring, early recognition of cardiac complications, and multidisciplinary management are critical. Long-term cardiac follow-up should be considered in patients with catecholamine-secreting tumors.
Chirkinyan et al. (Fri,) conducted a case report in Paraganglioma (n=1). Bilateral carotid body paraganglioma resection was evaluated on Takotsubo cardiomyopathy. Bilateral carotid body paraganglioma resection precipitated Takotsubo cardiomyopathy in a 32-year-old patient, with troponin rising to 1100 ng/mL and subsequent recovery to 50% ejection fraction.