Pheochromocytoma presenting as acute decompensated heart failure reversed with medical therapy

Abstract

A 26-year-old woman presented to hospital with acute chest pain, hypertension, tachycardia and an elevated serum creatinine. She developed respiratory distress requiring endotracheal intubation and mechanical ventilation. She progressed to multiorgan failure due to decompensated congestive heart failure. Echocardiography demonstrated global hypokinesis and an ejection fraction of <10%. Her cardiac function improved with fluid resuscitation and β blockade, and she was eventually discharged home. She was readmitted a few days later with pancreatitis after presenting with nausea, abdominal pain and hypertension. During hospitalisation she had paroxysms of headache, nausea and diaphoresis associated with hypertension and tachycardia. A CT scan of her abdomen revealed an adrenal mass and serum metanephrine studies confirmed the diagnosis of pheochromocytoma. After fluid resuscitation and sympathetic blockade her ejection fraction improved to 55%. The patient underwent an uneventful adrenalectomy and made a complete recovery.

Figure 1

(A) Baseline ECG: severely reduced left ventricle systolic function with an estimated ejection fraction of less than 10%. Reduced right ventricle cavity size, appearing under filled. (B) Preoperative ECG: normal global left ventricular systolic function with an estimated ejection fraction of 55%. Normal right ventricular size.

Figure 2

Paroxysm of hypertension and tachycardia.

Figure 3

Tumour athology. (A) Gross specimen of tumour: gross specimen of left adrenal containing tumour weighing 28 g and measuring 5.2×3.2×3.0 cm. (B) Histology of tumour: solid tumour and nesting cellular pattern with finely granular eosinophilic cytoplasm and no evidence of necrosis, capsular invasion or vascular invasion.