Pheochromocytoma Presenting as Fulminant Cardiogenic Shock following Maltiple Organ Failure

Abstract

Pheochromocytoma is an endocrine tumor classically presenting with headache, paroxysmal hypertension, and palpitations, which is often undiagnosed when cardiovascular complications, such as acute heart failure, myocardial infarction, angina pectoris, arrhymias, and dilated cardiomyopathy, presented as the initial clinical manifestations. Failure to identify a pheochromocytoma in these situations may be fatal. We discuss the case of a female, presenting with acute heart failure and cardiogenic shock requiring stabilization with ionotropes and vasopressors. Echocardiography revealed severe global hypokinesia of the dilated left ventricle. Pheochromocytoma was diagnosed by CT scan, as well as urine and plasma metanephrines. After the patient recovered with intensive medical treatment, the patient underwent adrenalectomy without complications. Follow-up echocardiography revealed normalized cardiac function and chamber dimensions. Despite the rarity of the tumor, this case demonstrates the utility of evaluating for pheochromocytoma, as it may identify a reversible cause of cardiomyopathy.