Postpartum pheochromocytoma crisis associated with cardiogenic shock and Sheehan's syndrome

Abstract

We report a case of a woman in her mid-30s who developed severe cardiac shock hours after giving birth to her second child with the need for extracorporeal haemodynamic support. Initially, postpartum cardiomyopathy was suspected, and high-urgency heart transplantation was considered. However, the endocrine work-up and imaging revealed pheochromocytoma as the cause for acute heart failure that was completely reversible. Notably, the patient also developed Sheehan's syndrome with pituitary necrosis and sustained hypopituitarism, most likely as a consequence of the haemodynamic failure during pheochromocytoma crisis. While pheochromocytoma crisis is already an extremely rare peripartum complication, the current case is-to the best of our knowledge-the first report of pheochromocytoma associated with Sheehan's syndrome. This case also highlights the clinical conundrum that pheochromocytomas can be easily overlooked in pregnancy due to non-specific symptoms and confusion with pregnancy-related hypertension or hypertension-associated other diseases. Appropriate case detection is important, especially in pregnant women with early onset of hypertension.

Keywords: Adrenal disorders; Heart failure; Intensive care; Pituitary disorders; Pregnancy.

Figure 1. Both MRI (a) and F-DOPA PET/CT (b) reveal a large cystic mass in the upper right abdomen. Positive F-DOPA uptake in the PET scan (b) confirms the suspected diagnosis of haemorrhagic pheochromocytoma. F-DOPA PET/CT: 18-fluorodopa positron emission tomography CT scan.

Figure 2. Pituitary MRI with paracoronal (a) and sagittal (b) T1-weighted images after contrast administration demonstrate a lack of central contrast enhancement (arrows) of the anterior pituitary lobe resulting in rim enhancement, in accordance with pituitary necrosis.