Clinical Features and Outcome of Pheochromocytoma-Induced Takotsubo Syndrome: Analysis of 80 Published Cases

Myriads of physical stress factors including pheochromocytoma have been reported triggering takotsubo syndrome (TS). The aim of this study was to report on the clinical features and outcome of pheochromocytoma-induced TS (Pheo-TS) in a large cohort of patients. Eighty published cases of Pheo-TS were retrieved from the literature and compared with 1,750 cases of all patients with TS (All-TS) published recently by Templin et al. Patients with Pheo-TS were on average 19.87 years younger than those with All-TS (p <0.0001). The women were still predominating in Pheo-TS but significantly in a lower percentage (70% in Pheo-TS vs 89.8% in All-TS, p <0.00001). Almost 1/3 (30%) of Pheo-TS cases had basal TS pattern compared with 2.2% of cases in All-TS (p <0.00001) and 1/5 (20%) had global TS compared with no cases in All-TS. Two thirds of Pheo-TS cases (67.9%) developed complications, which was significantly higher than complication rates in All-TS (21.8%), but there was no difference in the inhospital mortality between the 2 studies. The most important risk factors for the development of complications in Pheo-TS were age <50 years and global and basal TS localization patterns. The recurrence rate of 17.7% in Pheo-TS was significantly higher than the 3.26% in All-TS (p <0.00001). In conclusion, Pheo-TS is characterized by a dramatic clinical presentation with high complication rates and relatively high recurrence rate. Patients with Pheo-TS are significantly younger than All-TS. The TS localization pattern in Pheo-TS differed significantly from All-TS with basal pattern in almost 1/3 of cases and global pattern in 1/5 of the cases.