Hypertensive Crisis, Catecholamine Cardiomyopathy, and Death Associated with Pseudoephedrine use in a Patient with Pheochromocytoma

Abstract

To describe a woman with a previously unrecognized pheochromocytoma who died after ingesting over-the-counter pseudoephedrine-containing medications. We present a case report including laboratory, radiographic, and pathologic findings in a patient with a previously unrecognized pheochromocytoma. A 31-year-old woman had symptoms consistent with intermittent, excessive release of catecholamines since childhood. She developed an upper-respiratory infection and used over-the-counter medications containing pseudoephedrine. Subsequently, she developed a hypertensive crisis with congestive heart failure and died of a cardiac arrhythmia and shock. Findings from postmortem examination included a right adrenal pheochromocytoma, congestive heart failure, and catecholamine cardiomyopathy. This patient death may be linked to the use of pseudoephedrine hydrochloride. Physicians and pharmacists should warn patients with known pheochromocytoma or those at risk for having pheochromocytoma on the basis of family history or genetic testing that pseudoephedrine use may be harmful. Over-the-counter packaging should include such warning.