Pheochromocytoma underlying hypertension, stroke, and dilated cardiomyopathy

Abstract

We report the case of a 65-year-old man with a 6-year history of hypertension who presented with dilated cardiomyopathy, a transient cerebrovascular event, paroxysmal sweating, and intractable hypertension. Coronary angiography revealed no abnormality, but diagnostic testing was pursued because of the severe sweating and hypertension. Two-dimensional echocardiography showed 4-chamber dilatation with decreased left ventricular contractility. Further investigation, including a computed tomographic scan of the abdomen, led to a diagnosis of pheochromocytoma. Surgical resection of a left adrenal pheochromocytoma quickly resolved the patient's hypertension and resulted in substantially improved cardiac function after 4 months. Although pheochromocytoma has rarely been reported in the presence of both dilated cardiomyopathy and cerebrovascular events, it should be included in the differential diagnosis when patients present with dilated cardiomyopathy and a cerebrovascular event that have no obvious cause.

Fig. 1 A chest radiograph shows moderate cardiomegaly and pulmonary congestion.

Fig. 2 An enhanced abdominal computed tomographic scan shows a large (8 × 5 × 14-cm) left adrenal mass (arrow) with areas of necrosis and hemorrhagic fluid.