Bilateral Pheochromocytoma Masquerading as Acute Severe Congestive Heart Failure in a Juvenile Male Subject: A Case Report and Review of Literature

Introduction: Pheochromocytomas are rare neuroendocrinetumours of the adrenal medulla that do not always presentwith classical triad of headache, palpitations and diaphoresisalong with paroxysmal or sustained hypertension. Herein wepresent a case of young boy with pheochromocytoma whopresented initially with congestive cardiac failure with noother significant manifestation.Case report: A 17 -year-old boy was admitted in ouremergency with 2 months history of unevaluated headacheand one day history of breathlessness along with syncopalattacks. His initial clinical evaluation was suggestive ofcongestive cardiac failure (CCF) with hypotension. Afterinitial stabilization he was shifted to intensive care unit (ICU)where his echocardiography revealed dilated cardiomyopathywith severe mitral regurgitation. Because of young ageof presentation and no past significant medical historyneuroendocrine cause for cardiac illness was suspected.Further investigations revealed grossly elevated levels ofnormetanephrines in 24-hour urine collection. Imaging studiesincluding ultrasonography followed by computed tomographyof abdomen and I123 MIBG confirmed presence of bilateralpheochromocytoma. An open bilateral adrenalectomywas performed successfully after initial stabilisation.Patient was discharged after one-month postoperative care.Patient is presently in our follow up on low dose steroids,mineralocorticoids along with betablocker and has shownmarked improvement in biochemical and clinical parameters.Conclusion: Pheochromocytoma though a rare catecholamineproducing tumour but if not timely intervened can lead tolife-threatening consequences. Our case report highlights theimportance of high clinical suspicion of pheochromocytomaeven in young adolescent patients who present first time withacute severe CCF with dilated cardiomyopathy