Pheochromocytoma Presenting with Multiple Cardiovascular Manifestations

Abstract

IintroductionExcess concentrations of catecholamines in pheochromocytoma can cause various clinical manifestations. There are few reports of pheochromocytoma presented with stress-induced cardiomyopathy (catecholamine-induced cardiomyopathy) after mild stress and the case of pheochromocytoma associated with nonocclusive stroke is more uncommon.We report a case of pheochromocytoma manifested repeated stress-induced cardiomyopathy after mild stress featuring fulminant myocarditis and combined with non-occlusive stroke and ventricular tachycardia (VT). CaseA 56-year-old man who had no underlying disease, but who had experienced mild stress for a month, visited the emergency room (ER) of another hospital because of headache and abdominal pain 1 day before admission. Systolic and diastolic blood pressures (BPs) were 180/100 mmHg. The patient received prescriptions for hypertension and dyspepsia, and was sent home. Six hours later, headache and vomiting developed, prompting revisit to the ER. Pulmonary edema and elevations in creatine phosphokinase (CK)-MB and troponin-T were detected. The patient was admitted to the intensive care unit overnight and was transferred to our hospital the next day.The patient was a social drinker and non-smoker. Cardiomegaly and pulmonary edema were evident on chest radiography and an abdominal X-ray revealed paralytic ileus. ECG A 56-year-old man presented with sudden onset of congestive heart failure (New York Heart Association class III to IV) after mild stress and developed various cardiovascular manifestations. At first visit, cardiac enzyme elevation, regional left ventricular (LV) wall motion abnormality and pulmonary edema were evident. However, coronary angiography was normal. LV function was totally recovered at discharge, suspicious of fulminant myocarditis. During the hospital stay, acute non-obstructive stroke without neurologic sequelae occurred. After 3 years, he re-admitted because ventricular tachycardia and severe LV systolic dysfunction (ejection fraction, 15%) were developed. After 3 days of applying percutaneous cardiopulmonary bypass system, the patient was completely recovered. Suspicious of pheochromocytoma, we checked 24-hour urine catecholamines and metanephrines and abdomen computed tomography, which revealed pheochromocytoma. The patient underwent laparoscopic adrenalectomy. (Ewha Med J 2014;37(2):136-140)