Severe cardiomyopathy secondary to pheochromocytoma: Usefulness of magnesium sulfate. Case report

Abstract

The following report on the perioperative anesthetic management of severe cardiomyopathy and resection of pheochromocytoma tumors offers a clinical and pharmaceutical experience with a good outcome for a high-risk pathology with little available world literature. The female patient accesses emergency services in distress with tachycardia, labile blood pressure, dyspnea, and severe abdominal pain. Clinical studies reveal heart failure, an adrenal mass, and derivates of high levels of catecholamines in the blood, which leads to the diagnosis of severe cardiomyopathy induced by pheochromocytoma. The medical management for the acute crisis is performed with therapy in the intensive care unit, antihypertensives and magnesium sulfate. Once stabilized, a laparoscopic tumor resection followed. Her postoperative progress was adequate with a progressive resolution of symptoms. Cardiomyopathy secondary to pheochromocytoma is a pathology with high morbimortality and low frequency and is produced by the action of great quantities of catecholamines released subacutely due to hemorrhagic tumor necrosis or manipulation of the pheochromocytoma. It requires strict care in its acute crises and during surgery for its definitive resection. This report shows our experience with the usefulness of magnesium sulfate as a contributory drug in the control of this pathology throughout the perioperative period due to its mechanism of action and pharmacodynamics. Its easy availability in hospitals, the good clinical results it produces, and its scientific backing are important factors that make it a pharmacological option for pheochromocytoma.