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Management of concurrent aortic stenosis and pheochromocytoma
  1. Peter Kolyvas1,
  2. Govind Ramadurai2,
  3. Hazem Al Hawasli2 and
  4. Chris Kolyvas2
  1. 1Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
  2. 2Cardiology, Heartland Cardiovascular Center, Joliet, Illinois, USA
  1. Correspondence to Peter Kolyvas; pkolyvas{at}live.com

Abstract

A man in his mid 60s with known aortic stenosis developed progressive symptoms. Echocardiography confirmed severe calcific aortic stenosis. Further evaluation revealed an elevated white blood cell count leading to a diagnosis of chronic lymphocytic leukaemia. CT of the abdomen revealed a left adrenal mass, confirmed by MRI. 24-hour urine catecholamines were elevated, confirming the diagnosis of a pheochromocytoma.

This case was complicated by the concurrent aortic stenosis and pheochromocytoma, requiring considerable multidisciplinary teamwork to develop a safe management strategy. A decision to perform a transcatheter aortic valve replacement (TAVR) with alpha and beta blockade with monitored anaesthesia care followed by laparoscopic adrenalectomy and postoperative haemodynamic control was made. A successful TAVR procedure was performed, complicated only by postoperative transient atrial tachycardia followed 6 weeks later by a laparoscopic robotic-assisted left adrenalectomy. The patient recovered fully and was discharged 2 days later.

  • Adrenal disorders
  • Endocrinology
  • Valvar diseases
  • Interventional cardiology
  • Medical management

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Footnotes

  • Contributors Conception and design: GR, HAH, CK. Writing: PK. Review/editing: GR, CK, HAH. Overall responsibility/guarantor: CK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests GR is a consultant for Cardiovascular Systems Inc.

  • Provenance and peer review Not commissioned; externally peer reviewed.