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

Anesthetic experience of pheochromocytoma resection with catecholamine-induced cardiomyopathy and congestive heart failure : A case report / 대한마취과학회지

Catecholamine-induced cardiomyopathy associated with pheochromocytoma is a relatively well-recognized but rare entity. We report a case of 15-year old man with a pheochromocytoma and severe heart failure caused by a catecholamine-induced cardiomyopathy. He had symptoms such as fatigue, cold sweating, and dyspnea for 7 months. The chest x-ray showed an enlarged cardiac shadow and pulmonary edema. Echocardiography showed severe decreased left ventricular contractility with multiple thrombi and right ventricular hypokinesia with mild pulmonary hypertension. This report describes our experience of the anesthetic management for the removal of pheochromocytoma with catecholamine-induced cardiomyopathy, which barely responded to high vasopressin and epinephrine.

A Case of Pheochromocytoma Presented with Cardiogenic Shock / 대한내분비학회지

A pheochromocytoma is a catecholamine secreting tumor, which is often overlooked when cardiovascular complications, such as acute heart failure, myocardial infarction, angina pectoris, arrhythmias, and dilated cardiomyopathy, presented as the initial clinical manifestations. Failure to identify a pheochromocytoma in these situations may be fatal. We report the case of 32-year-old female, who presented with cardiogenic shock. Echocardiography revealed severe global hypokinesia of the dilated left ventricle, with the exception of the apex. Computed tomography of the aorta showed a well-enhanced left adrenal mass, 3.5cm in diameter. A 24 hour urine collection study for catecholamines and a 131I-metaiodobenzylguanidine(MIBG) scan were suggestive of the diagnosis of a single adrenal pheochromocytoma. The patient stabilized after shock management, and recovered with intensive medical treatment. Follow-up echocardiography revealed normalized cardiac function and chamber dimensions. Thereafter, the adrenal mass was successfully removed using laparaoscopic surgery, without complications

CARDIOVASCULAR COMPLICATIONS ASSOCIATED WITH PHEOCHROMOCYTOMA / 解放军医学杂志

Of 26 cases with pheochromocytoma which had been proved on operation,pathological examination was done in 21 cases.The authors analysed the cardiovascular complications in these patients and correlated them with the pathologic findings of the tumor.The results showed that patients with predominantly epinephrinesecreting tumors were prone to post-hypertesive hypotension,arrhythmia with rapid heart rate and catecholamine-induced myocardosis.Some illustrative examples were presented and path-ophysiology of these complications were discussed.