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中华重症医学电子杂志 ›› 2023, Vol. 09 ›› Issue (03) : 304 -310. doi: 10.3877/cma.j.issn.2096-1537.2023.03.013

病例报告

ECMO联合肾上腺切除救治妊娠期嗜铬细胞瘤并儿茶酚胺心肌病一例并文献回顾
方可, 笪欢欢, 汪君, 孙瑞祥, 王涛, 李阳, 江海娇(), 鲁卫华   
  1. 241000 安徽芜湖,安徽省危重症呼吸疾病临床医学研究中心 皖南医学院第一附属医院(弋矶山医院)重症医学科
    241000 安徽芜湖,安徽省危重症呼吸疾病临床医学研究中心 皖南医学院第一附属医院(弋矶山医院)麻醉手术室
  • 收稿日期:2022-10-09 出版日期:2023-08-28
  • 通信作者: 江海娇
  • 基金资助:
    安徽省医疗卫生重点专科建设项目(2021-273)

ECMO assisted adrenal excision for pheochromocytoma catecholamine cardiomyopathy during pregnancy: a case report and literature review

Ke Fang, Huanhuan Da, Jun Wang, Ruixiang Sun, Tao Wang, Yang Li, Haijiao Jiang(), Weihua Lu   

  1. Department of Critical Care Medicine, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Anhui Provincial Clinical Research Center for Critical Respiratory Disease, Wuhu 241000, China
    Anesthesia Operating Room, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Anhui Provincial Clinical Research Center for Critical Respiratory Disease, Wuhu 241000, China
  • Received:2022-10-09 Published:2023-08-28
  • Corresponding author: Haijiao Jiang
引用本文:

方可, 笪欢欢, 汪君, 孙瑞祥, 王涛, 李阳, 江海娇, 鲁卫华. ECMO联合肾上腺切除救治妊娠期嗜铬细胞瘤并儿茶酚胺心肌病一例并文献回顾[J]. 中华重症医学电子杂志, 2023, 09(03): 304-310.

Ke Fang, Huanhuan Da, Jun Wang, Ruixiang Sun, Tao Wang, Yang Li, Haijiao Jiang, Weihua Lu. ECMO assisted adrenal excision for pheochromocytoma catecholamine cardiomyopathy during pregnancy: a case report and literature review[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(03): 304-310.

嗜铬细胞瘤是一组罕见的能够产生儿茶酚胺的肿瘤,临床主要以高血压、头痛、大汗、心悸为主,心源性休克很少为嗜铬细胞瘤的首发表现。笔者所在医院近期收治1例以心源性休克为首发临床表现的孕31+3周患者,初诊考虑为急性心肌炎并行静脉动脉体外膜肺氧合(VA-ECMO)治疗,心功能快速得到改善,但在ECMO撤机的过程中再度发生心源性休克,再次启动VA-ECMO辅助治疗。查腹部CT及24 h尿、血浆甲氧基肾上腺素类物质(MNs)明确诊断为嗜铬细胞瘤并儿茶酚胺心肌病,二次ECMO期间出现离心泵头血栓,在ECMO保护下紧急联合外科完成了肾上腺嗜铬细胞瘤切除,并于当日成功撤离ECMO,术后9 d产妇顺利出院。笔者总结本例产妇救治经过,并对相关病例报道进行回顾,为嗜铬细胞瘤并儿茶酚胺心肌病的临床救治提供参考。

Pheochromocytoma is a group of rare tumors produce catecholamines. Clinical manifestations are mainly hypertension, headache, sweating, and palpitation. Cardiogenic shock rarely appears as the first manifestation of pheochromocytoma. A pregnant patient of 31+3 weeks was admitted to our hospital recently with cardiogenic shock as the first clinical manifestation. Initial diagnosis was considered as acute myocarditis and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was started. Her cardiac function rapidly improved, however, cardiogenic shock occurred again during ECMO withdrawal, and VA-ECMO was started again. Though abdominal CT examination and 24 hour urine and plasma methoxyepinephrine substances (MNs), diagnosis of pheochromocytoma with catecholamine cardiomyopathy was confirmed. With ECMO assistance, adrenal pheochromocytoma was removed with surgery. The patient was successfully evacuated from ECMO on the surgery day, discharged successfully after 9 days. The authors summarized the treatments in this case and reviewed related case reports, which could provide reference to treat pheochromocytoma catecholamine cardiomyopathy.

图1 妊娠期嗜铬细胞瘤并儿茶酚胺心肌病患者影像学检查、ECMO泵头血栓情况、手术及术后病理资料。图a为腹部CTA显示左侧肾上腺有一肿瘤(白色箭头);图b为手机慢动作摄影显示泵头内有一血栓形成(白色箭头);图c、d为ECMO保护下通过腹腔镜手术完成左侧肾上腺肿物(6 cm×4 cm×4 cm)的完整切除;图e为左侧肾上腺肿物(嗜铬细胞瘤),绝大部分区域梗死;图f为ECMO撤机后冲洗泵头证实泵头内血栓形成(白色箭头) 注:CTA为CT血管成像;ECMO为体外膜肺氧合
表1 妊娠期嗜铬细胞瘤并儿茶酚胺心肌病患者24 h尿、血浆甲氧基肾上腺素类物质测定结果(nmol/24 h)
表2 VA-ECMO辅助嗜铬细胞瘤心源性休克的病例报道回顾
文献作者 年份 性别 年龄(岁) ECMO前LVEF(%) 妊娠 ECMO时间(d) 其他机械辅助 手术时机 术前准备时间(d) 二次ECMO 初始诊断 出院预后 术前撤离ECMO并发症
Grinda等11 2006 49 12 NR IABP; ECMO保护 NR PCC心肌病 存活 *
DeBakey-轴向泵
Chao等12 2008 42 20 7 IABP ECMO撤机后 >18 急性心肌炎 存活
Suh等13 2008 43 35 4 IABP ECMO撤机后 56 PCC心肌病 存活
Huang等14 2008 25 38 4 IABP ECMO撤机后 NR 急性心肌炎 存活
42 NR 7 IABP ECMO撤机后 NR 急性心肌炎 存活 阵发性高血压
41 NR 2 IABP ECMO撤机后 NR 急性心肌炎 存活
Wu等15 2008 42 34 8 IABP ECMO撤机后 21 急性心肌炎 存活 严重高血压
40 30 4 IABP ECMO撤机后 12 急性心肌炎 存活
Ritter等16 2011 49 NR 8 ECMO保护 4 急性心肌炎 存活 *
Sheinberg等17 2012 45 5~10 2 IABP 未手术 ECPR PCC心肌病 死亡 高血压危象;
心脏停搏
Banfi等18 2012 20 5~10 6 ECMO撤机后 4个月 PCC 存活
Sojod等19 2012 37 15 11 ECMO撤机后 21 PCC心肌病 存活
Kaese等20 2013 43 NR 9 ECMO撤机后 NR TTS 存活
Flam等21 2014 46 ECPR 7 ECMO撤机后 59 PCC;TTS 存活
Mita等22 2016 29 NR 37周 6 IABP ECMO撤机后 30 羊水栓塞 存活
van Zwet等23 2016 27 20 35+2 5 ECMO撤机后 15 VV-ECMO PPCM 存活
Dang Van等24 2016 57 10 7 ECMO保护 NR PCC 存活 *
Hekimian等25 2016 41 5 4 未手术 VA-ECMO 急性肺水肿 死亡 严重高血压
44 20 <1 未手术 急性肺水肿 死亡
36 20 4 未手术 急性肺水肿 死亡
45 20 7 二次入院后 NR 急性心肌炎 存活
43 20 3 ECMO撤机后 42 TTS 存活
51 25 3 ECMO撤机后 42 TTS 存活
49 20 2 ECMO撤机后 42 急性心肌炎 存活
31 30 7 ECMO撤机后 42 心源性休克 存活
Bouabdallaoui等26 2017 40 NR 5 ECMO撤机后 38 心源性休克 存活
Haake等27 2017 48 NR 2 Impella ECMO撤机后 NR 急性心肌炎 存活
Martin-Villen等28 2018 41 17 12 ECMO保护 4 高血压危象 存活 *
Garla等29 2019 55 10 5 IABP ECMO撤机后 16 PCC心肌病 存活
Mierke等30 2019 47 15 7 pLVAD ECMO撤机后 24 心源性休克 存活
Kiamanesh等31 2019 45 15 3 ECMO撤机后 14 急性心肌炎 存活
Su等32 2019 31 35 NR ECMO撤机后 28 急性心肌炎 存活
Faria等33 2020 26 NR 10 ECMO撤机后 25 PCC心肌病 存活
Dominedò等34 2021 28 20~30 4 Impella ECMO撤机后 16 高血压危象 存活
Park等35 2021 29 ECPR 28周 8 ECMO撤机后 NR 急性心肌炎 存活
Attisani等36 2021 53 15 5 ECMO撤机后 12 PCC心肌病 存活
33 15 6 IABP ECMO撤机后 28 心源性休克 存活
Myatt等37 2021 36 15 24+1 <10 二次入院后 NR 先兆子痫 存活
Wang等38 2021 29 15 56 d 4 ECMO撤机后 NR 甲亢危象 存活 顽固性高血压
Luo等39 2022 46 NR 6 ECMO保护 28 麻醉副作用 存活 *
Lyu等40 2022 54 20 7 ECMO保护 6 STEMI 存活 *
1
Mann DL, Zipes DP, Libby P, et al. Braunwald's Heart Disease: a Textbook of Cardiovascular Medicine [M]. Philadelphia: Elsevier Saunders, 2015.
2
Santos JRU, Brofferio A, Viana B, et al. Catecholamine-induced cardiomyopathy in pheochromocytoma: how to manage a rare complication in a rare disease [J]. Horm Metab Res, 2019, 51(7): 458-469.
3
Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline [J]. J Clin Endocrinol Metab, 2014, 99(6): 1915-1942.
4
Cohen DL, Fraker D, Townsend RR. Lack of symptoms in patients with histologic evidence of pheochromocytoma: a diagnostic challenge [J]. Ann N Y Acad Sci, 2006, 1073: 47-51.
5
Mobine HR, Baker AB, Wang L, et al. Pheochromocytoma-induced cardiomyopathy is modulated by the synergistic effects of cell-secreted factors [J]. Circ Heart Fail, 2009, 2(2): 121-128.
6
Giavarini A, Chedid A, Bobrie G, et al. Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma [J]. Heart, 2013, 99(19): 1438-1444.
7
Sauneuf B, Chudeau N, Champigneulle B, et al. Pheochromocytoma crisis in the ICU: a French multicenter cohort study with emphasis on rescue extracorporeal membrane oxygenation [J]. Crit Care Med, 2017, 45(7): e657-e665.
8
Matteucci M, Kowalewski M, Fina D, et al. Extracorporeal life support for phaeochromocytoma-induced cardiogenic shock: a systematic review [J]. Perfusion, 2020, 35(suppl 1): 20-28.
9
Neumann HPH, Young WFJr, Eng C. Pheochromocytoma and paraganglioma [J]. N Engl J Med, 2019, 381(6): 552-565.
10
Müller G, Saint F, Hamy A, et al. Pheochromocytoma revealed by acute heart failure. When should we operate? Presented at the ESES Congress, Gothenburg May 25-26, 2012 [J]. Langenbecks Arch Surg, 2013, 398(5): 729-733.
11
Grinda JM, Bricourt MO, Salvi S, et al. Unusual cardiogenic shock due to pheochromocytoma: recovery after bridge-to-bridge (extracorporeal life support and DeBakey ventricular assist device) and right surrenalectomy [J]. J Thorac Cardiovasc Surg, 2006, 131(4): 913-914.
12
Chao A, Yeh YC, Yen TS, et al. Phaeochromocytoma crisis--a rare indication for extracorporeal membrane oxygenation [J]. Anaesthesia, 2008, 63(1): 86-88.
13
Suh IW, Lee CW, Kim YH, et al. Catastrophic catecholamine-induced cardiomyopathy mimicking acute myocardial infarction, rescued by extracorporeal membrane oxygenation (ECMO) in pheochromocytoma [J]. J Korean Med Sci, 2008, 23(2): 350-354.
14
Huang JH, Huang SC, Chou NK, et al. Extracorporeal membrane oxygenation rescue for cardiopulmonary collapse secondary to pheochromocytoma: report of three cases [J]. Intensive Care Med, 2008, 34(8): 1551-1552.
15
Wu XM, Chen JJ, Wu CK, et al. Pheochromocytoma presenting as acute myocarditis with cardiogenic shock in two cases [J]. Intern Med, 2008, 47(24): 2151-2155.
16
Ritter S, Guertler T, Meier CA, et al. Cardiogenic shock due to pheochromocytoma rescued by extracorporeal membrane oxygenation [J]. Interact Cardiovasc Thorac Surg, 2011, 13(1): 112-113.
17
Sheinberg R, Gao WD, Wand G, et al. Case 1-2012. A perfect storm: fatality resulting from metoclopramide unmasking a pheochromocytoma and its management [J]. J Cardiothorac Vasc Anesth, 2012, 26(1): 161-165.
18
Banfi C, Juthier F, Ennezat PV, et al. Central extracorporeal life support in pheochromocytoma crisis [J]. Ann Thorac Surg, 2012, 93(4): 1303-1305.
19
Sojod G, Diana M, Wall J, et al. Successful extracorporeal membrane oxygenation treatment for pheochromocytoma-induced acute cardiac failure [J]. Am J Emerg Med, 2012, 30(6): 1017.e1-3.
20
Kaese S, Schülke C, Fischer D, et al. Pheochromocytoma-induced takotsubo-like cardiomyopathy and global heart failure with need for extracorporal life support [J]. Intensive Care Med, 2013, 39(8): 1473-1474.
21
Flam B, Broomé M, Frenckner B, et al. Pheochromocytoma-induced inverted takotsubo-like cardiomyopathy leading to cardiogenic shock successfully treated with extracorporeal membrane oxygenation [J]. J Intensive Care Med, 2015, 30(6): 365-372.
22
Mita K, Tsugita K, Yasuda Y, et al. A successfully treated case of cardiac arrest after Caesarean section complicated by pheochromocytoma crisis and amniotic fluid embolism [J]. J Anesth, 2017, 31(1): 140-143.
23
van Zwet CJ, Rist A, Haeussler A, et al. Extracorporeal membrane oxygenation for treatment of acute inverted takotsubo-like cardiomyopathy from hemorrhagic pheochromocytoma in late pregnancy [J]. A A Case Rep, 2016, 7(9): 196-199.
24
Van Dang S, Hamy A, Hubert N, et al. Cardiogenic shock induced by a voluminous phaeochromocytoma rescued by concomitant extracorporeal life support and open left adrenalectomy [J]. Eur J Cardiothorac Surg, 2016, 50(4): 782-783.
25
Hekimian G, Kharcha F, Bréchot N, et al. Extracorporeal membrane oxygenation for pheochromocytoma-induced cardiogenic shock [J]. Ann Intensive Care, 2016, 6(1): 117.
26
Bouabdallaoui N, Bouchard D, Jolicoeur EM, et al. Extracorporeal membrane oxygenation in pheochromocytoma-induced cardiogenic shock [J]. Asian Cardiovasc Thorac Ann, 2018, 26(4): 314-316.
27
Haake H, Grün-Himmelmann K, Kania U, et al. Treatment of an uncommon case of a cardiogenic shock : Simultaneous use of a VA-ECMO and an Impella-CP® [J]. Med Klin Intensivmed Notfmed, 2018, 113(2): 131-134.
28
Martin-Villen L, Corcia-Palomo Y, Escalona-Rodriguez S, et al. Extracorporeal membrane oxygenation support in a patient with pheochromocytoma stress myocardyopathy [J]. Med Intensiva (Engl Ed), 2018, 42(9): 566-568.
29
Garla VV, Gosi S, Kanduri S, et al. A case of catecholamine-induced cardiomyopathy treated with extracorporeal membrane oxygenation [J]. BMJ Case Rep, 2019, 12(9): e230196.
30
Mierke J, Loehn T, Linke A, et al. Reverse takotsubo cardiomyopathy- life-threatening symptom of an incidental pheochromocytoma: a case report [J]. Eur Heart J Case Rep, 2019, 3(4): 1-6.
31
Kiamanesh O, Vu EN, Webber DL, et al. Pheochromocytoma-induced takotsubo syndrome treated with extracorporeal membrane oxygenation: beware of the apical sparing pattern [J]. JACC Case Rep, 2019, 1(2): 85-90.
32
Su Z, Wang Y, Fei H. Takotsubo-like cardiomyopathy in pheochromocytoma [J]. CASE (Phila), 2019, 3(4): 157-161.
33
Faria BMM, Português J, Roncon-Albuquerque RJr, et al. Inverted takotsubo syndrome complicated with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation in a patient with bilateral pheochromocytoma: a case report [J]. Eur Heart J Case Rep, 2020, 4(2): 1-5.
34
Dominedò C, D'Avino E, Martinotti A, et al. A rare pheochromocytoma complicated by cardiogenic shock and posterior reversible encephalopathy syndrome: case report [J]. Eur Heart J Case Rep, 2021, 5(2): ytaa513.
35
Park S, Kim M, Lee DI, et al. Successful extracorporeal membrane oxygen-ation treatment of catecholamine-induced cardiomyopathy-associated pheochro-mocytoma [J/OL]. Acute Crit Care, 2022. Epub ahead of print.
36
Attisani M, Pocar M, Brenna D, et al. Extracorporeal membrane oxygenation with ventricular unloading allows for immediate adrenergic blockage in pheochromocytoma-induced cardiogenic shock [J]. J Cardiothorac Vasc Anesth, 2021, 35(10): 3039-3041.
37
Myatt T, Barker M. Pheochromocytoma leading to multiorgan failure in a pregnant patient: a case report [J]. Clin Pract Cases Emerg Med, 2021, 5(4): 394-398.
38
Wang T, Xu Q, Jiang X. Successful extracorporeal membrane oxygenation resuscitation of patient with cardiogenic shock induced by phaeochromocytoma crisis mimicking hyperthyroidism: a case report [J]. Open Life Sci, 2021, 16(1): 746-751.
39
Luo S, Cui Q, Wang D. Case report: surgical intervention under pheochromocytoma multisystem crisis: timing and approach [J]. Front Oncol, 2022, 12: 908039.
40
Lyu T, Niu J, Liu Z, et al. Case report: early resection of pheochromocytoma in a patient with cardiogenic shock due to pheochromocytoma-induced cardiomyopathy with extracorporeal life support [J]. Front Cardiovasc Med, 2022, 9: 788644.
41
Shah MH, Goldner WS, Benson AB, et al. Neuroendocrine and adrenal tumors, version 2. 2021, NCCN clinical practice guidelines in oncology [J]. J Natl Compr Canc Netw, 2021, 19(7): 839-868.
42
Wittstein IS. Stress cardiomyopathy: a syndrome of catecholamine-mediated myocardial stunning [J]. Cell Mol Neurobiol, 2012, 32(5): 847-857.
43
Prejbisz A, Lenders JW, Eisenhofer G, et al. Cardiovascular manifestations of phaeochromocytoma [J]. J Hypertens, 2011, 29(11): 2049-2060.
44
中华医学会内分泌学分会. 嗜铬细胞瘤和副神经节瘤诊断治疗专家共识(2020版) [J]. 中华内分泌代谢杂志, 2020, 36(9): 737-750.
45
Harrington JL, Farley DR, van Heerden JA, et al. Adrenal tumors and pregnancy [J]. World J Surg, 1999, 23(2): 182-186.
46
Biggar MA, Lennard TW. Systematic review of phaeochromocytoma in pregnancy [J]. Br J Surg, 2013, 100(2): 182-190.
47
Sarathi V, Lila AR, Bandgar TR, et al. Pheochromocytoma and pregnancy: a rare but dangerous combination [J]. Endocr Pract, 2010, 16(2): 300-309.
48
Neal JR, Quintana E, Pike RB, et al. Using daily plasma-free hemoglobin levels for diagnosis of critical pump thrombus in patients undergoing ECMO or VAD support [J]. J Extra Corpor Technol, 2015, 47(2): 103-108.
49
Diehl A, Gantner D. Pump head thrombosis in extracorporeal membrane oxygenation (ECMO) [J]. Intensive Care Med, 2018, 44(3): 376-377.
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