Chest
Volume 99, Issue 2, February 1991, Pages 382-385
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Clinical Investigations
Catecholamine-induced Cardiomyopathy in Multiple Endocrine Neoplasia: A Histologic, Ultrastructural, and Biochemical Study

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A catecholamine-induced dilated cardiomyopathy is reported in a patient with multiple endocrine neoplasia, type 3. A histologic and ultrastructural study has been undertaken in cardiac biopsy samples, together with determination of myocardial Ca++ and cellular membrane fatty acids. Contraction band necrosis of cardiocytes with supercontraction of sarcomeres progressing to myofibrolysis and increased levels of myocardial Ca++ have been found as morphologic and biochemical abnormalities, respectively. No lipoperoxidation of cellular membranes or an α-adrenergic mediated reduction of coronary supply could be recognized in the study. We indicate a receptor-mediated intracellular Ca++ overload as the main abnormality responsible for myocardial impairment.

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CASE REPORT

A 33-year-old man was admitted because of dyspnea on effort. He had suffered since childhood with dilatation of the stomach, megacolon, and bilateral megaloureter. At the age of 18 years, he had undergone left hemithyroidectomy because of a tumor. In the previous two years, he had developed a moderate hypertension, which was controlled by diuretics and serum converting enzyme inhibitors. At the time of admission, physical examination revealed a tall, slender, and hypotonic patient with enlarged

DISCUSSION

Bilateral pheochromocytomas have been observed in a patient with medullary thyroid carcinoma and mucosal neuromatosis of the tongue, stomach, and colon (megacolon), which is the typical configuration of multiple endocrine neoplasia, type 3.9 The major cardiovascular feature was a catecholamine-induced dilated cardiomyopathy, which is rare and has not been previously described in multiple endocrine neoplasia, type 3. At light microscopy, myocardial biopsy samples showed hypertrophy, with

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