A case of pheochromocytoma presenting with cardiopulmonary arrest

Abstract

A 33-year-old woman complained of sudden chest pain and intense headache. She was unconscious and underwent defibrillation for ventricular fibrillation in the ambulance. In the emergency room, she was placed on an artificial respirator. Diffuse wall hypokinesis and decreased left ventricular ejection fraction (31%) were identified on transthoracic echocardiography, and an intra-aortic balloon pump was inserted to address the cardiogenic shock. A mass was identified in the right adrenal gland on abdominal ultrasonography. Since a pheochromocytoma was suspected, doxazosin and carvedilol were administered. Blood and urinary norepinephrine and dopamine levels were elevated, confirming the pheochromocytoma diagnosis, and right adrenalectomy was performed 23 days after the initial hospitalization. After surgery, the left ventricular wall motion and left ventricular ejection fraction had improved to 62% on echocardiography. Blood and urinary norepinephrine and dopamine levels also decreased to within the normal range. This case highlights that the patient returned to normalcy and recovered to a transient myocardial disorder or malignant arrhythmia after cardiopulmonary arrest due to early diagnosis of and accurate treatment for pheochromocytoma. <Learning objective: Pheochromocytomas secrete excessive levels of catecholamines that may cause cardiac dysfunction, including fatal arrhythmias. It is necessary for the transient hypertension and fatal arrhythmia appearance to consider the possibility of pheochromocytoma. The decreased cardiac function may be reversible with resection of the tumor. Therefore, early diagnosis and treatment can be lifesaving in such cases. Pheochromocytomas provide an interesting model to evaluate the vulnerability of the myocardium to adrenergic stimulation, such as in cases of takotsubo cardiomyopathy or catecholamine-induced cardiomyopathy.>.

Keywords: Left ventricular dysfunction; Pheochromocytoma; Ventricular fibrillation.

Fig. 1

Ventricular fibrillation detected by an external defibrillator.

Fig. 2

Abdominal ultrasound image showing a 24 × 22-mm mass in the right adrenal gland.

Fig. 3

(A) Hematoxylin and eosin staining showing polygonal cells and cluster of tumor cells(×12.5). (B) Immunohistochemical staining showing chromogranin and cytoplasmic immunoreactivity(×12.5).