Pheochromocytoma presenting as life-threatening pulmonary edema.

Abstract

Acute cardiogenic pulmonary edema as the first presentation of pheochromocytoma is uncommon and usually rapidly fatal. A 39-yr-old man presented in acute cardiogenic shock with global ventricular dysfunction that required high-dose iv inotrope support and an intraaortic balloon pump assist device. Abdominal imaging to exclude aortic dissection revealed a 6-cm right adrenal mass. Significant myocardial infarction (electrocardiographic changes and elevated cardiac enzymes) contributed to the cardiac decompensation. After withdrawal of inotrope support, 24-h urinary catecholamine levels revealed 2,155 nmol/d (<125) of adrenaline and 7,437 nmol/d (<560) of noradrenaline, confirming a pheochromocytoma. The tumor was successfully removed at laparotomy; however, the patient's course was complicated by a thromboembolic cerebrovascular accident with paraplegia. He recovered cardiac function almost completely within 3 wk of medical therapy alone. Although uncommon, this case highlights the need to consider pheochromocytoma early in the management of unexplained cardiogenic shock.

• Authors: J Kaye, S Edlin, I Thompson, P J Leedma
• Journal: Endocrine (Endocrine) Vol. 15 Issue 2 Pg. 203-4 (Jul 2001) ISSN: 1355-008X [Print] United States
• PMID: 11720247 (Publication Type: Case Reports, Journal Article)

Chemical References

• Norepinephrine
• Epinephrine

Topics

• Adrenal Gland Neoplasms (complications, diagnosis, surgery)
• Adult
• Electrocardiography
• Epinephrine (urine)
• Humans
• Male
• Myocardial Infarction (diagnosis, etiology)
• Norepinephrine (urine)
• Paraplegia (complications)
• Pheochromocytoma (complications, diagnosis, surgery)
• Pulmonary Edema (etiology)
• Shock, Cardiogenic (etiology)
• Stroke (complications)
• Thromboembolism (complications)