Catecholamine-induced Myocarditis in Pheochromocytoma

ABSTRACT

Pheochromocytomas are rare tumors that originate in chromaffin tissue and produce distant variant effects, such as EKG abnormality, myocarditis, cardiomyopathy, and acute coronary syndrome, by secretion of catecholamines. Such variant effects of pheochromocytoma tend to lead the emergency physician to a wrong diagnosis. We describe the case of a 29-year-old female with pheochromocytoma who was diagnosed at the ER as having myocarditis with acute renal failure. The diagnosis of pheochromocytoma was made later. To avoid misdiagnosis, we should include pheochromocytoma in the differential diagnosis. We should also use additional imaging tests, such as bed-side abdominal ultrasonography or abdominal CT, at the ER on relatively young patients presenting with hypertensive crisis, acute renal failure, and features, such as ischemic EKG changes, which are suggestive of acute coronary syndrome or myocarditis.