Catecholamine-induced cardiomyopathy

Endocr Pract. 2008 Dec;14(9):1137-49. doi: 10.4158/EP.14.9.1137.


Objective: To review the pathogenesis as well as the clinical and laboratory features of catecholamine-induced cardiomyopathy associated with pheochromocytoma and other disorders and discuss the various treatment options available.

Methods: Materials used for this article were identified through MEDLINE, PubMed, and Google Scholar searches of the relevant literature from 1955 to the present.

Results: Catecholamines and their oxidation products cause a direct toxic effect on the myocardium. Catecholamines also exert a receptor-mediated effect on the myocardium. Catecholamine-mediated myocardial stunning has been implicated in the pathogenesis of stress-induced cardiomyopathy. Biopsy of the myocardium in patients with pheochromocytoma or those with stress-induced cardiomyopathy shows similar pathologic findings. The clinical features in pheochromocytoma-related cardiomyopathy include hypertension, dilated or hypertrophic cardiomyopathy, pulmonary edema due to cardiogenic and noncardiogenic factors, cardiac arrhythmias, and even cardiac arrest. Stress-related cardiomyopathy such as takotsubo cardiomyopathy occurs primarily in postmenopausal women. These patients may present with clinical features suggestive of an acute myocardial infarction or a hemodynamically compromised state. The definitive management of cardiomyopathy associated with pheochromocytoma includes medical treatment with alpha-adrenergic blockade, possibly along with angiotensin converting enzyme blockers and beta1-adrenergic receptor blockers, followed by excision of the tumor. Stress-induced cardiomyopathy is usually self-limiting; patients may require support with nonadrenergic inotropes.

Conclusion: Recognition of catecholamine-induced cardiomyopathy, especially in patients with pheochromocytoma, before surgical treatment is important to minimize morbidity and mortality.

Publication types

  • Review

MeSH terms

  • Adrenal Gland Neoplasms / complications*
  • Adrenal Gland Neoplasms / epidemiology
  • Adrenal Gland Neoplasms / metabolism
  • Animals
  • Cardiomyopathies / diagnosis
  • Cardiomyopathies / epidemiology
  • Cardiomyopathies / etiology*
  • Cardiomyopathies / therapy
  • Catecholamines / adverse effects*
  • Catecholamines / metabolism
  • Humans
  • Myocardium / pathology
  • Pheochromocytoma / complications*
  • Pheochromocytoma / epidemiology
  • Pheochromocytoma / metabolism
  • Prevalence
  • Prognosis


  • Catecholamines