Endocrinol Metab.  2010 Sep;25(3):240-244. 10.3803/EnM.2010.25.3.240.

A Case of Pheochromocytoma Crisis with Acute Myocardial Infarction Induced by Glucocorticoids Administration

• Rou WS
• Jung SK
• Lee SY
• Lee YJ
• Kim DJ
• Kim YD
• Kim HY
• Chang S
• Noh JH

• KMID: 2169071
• DOI: http://doi.org/10.3803/EnM.2010.25.3.240

Abstract

The most common symptoms of pheochromocytoma are paroxysmal or sustained hypertension, or symptoms of paroxysmal adrenergic stimulation such as palpitation, headache, and diaphoresis. These patients can on rare occasion reveal or be complicated with cardiovascular symptoms such as arrhythmia, cardiomyopathy, acute coronary syndrome and cardiogenic shock. These cardiac manifestations of pheochromocytoma may delay the diagnosis, which can cause a catastrophic outcome. A pheochromocytoma crisis is provoked by surgery, anesthesia, exercise and, several drugs and it is known to be an endocrine emergency with mortality as high as 85%. Many classes of drugs are well known to precipitate adverse reactions, but the presentation of pheochromocytoma after the administration of steroid has rarely been reported. We report here on a case of pheochromocytoma crisis with acute myocardial infarction after the patient took prednisolone. Furthermore, we discuss the mechanism of glucocorticoid induced crisis and myocardial infarction in pheochromocytoma patients.

Keyword

Glucocorticoids; Myocardial infarction; Pheochromocytoma

MeSH Terms

Acute Coronary Syndrome
Anesthesia
Arrhythmias, Cardiac
Cardiomyopathies
Emergencies
Glucocorticoids
Headache
Humans
Hypertension
Myocardial Infarction
Pheochromocytoma
Prednisolone
Shock, Cardiogenic
Glucocorticoids
Prednisolone

Figure

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  Fig. 1 Initial ECG at emergency room showed T wave inversion in precordial leads.

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  Fig. 2 Chest PA at admission reveals cardiomegaly, but no significant edema or active infiltrate.

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  Fig. 3 Abdominal CT cross-section (A) and sagittal section (B) show 3.1 × 3.7 cm sized well-defined round ovoid shape mass with suspected necrosis or cystic change.

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  Fig. 4 A. Gross findings of the surgical specimen. The tumor is well demarcated with tan surface and central degeneration. Residual attached adrenal gland is present. B-D. Microscopic examination of the specimen. Organoid clusters of tumor cells are noted. The tumor cells have lavendar cytoplasm with punctate granularity (B, H&E, × 200). The tumor shows positive immunostaining for chromogranin (C, immunohistochemistry, × 200). Cells positive for S-100 protein are angular to stellate and are located at the periphery of alveolar clusters of tumor cells. These cells represent sustentacular cells (D, immunohistochemistry, × 100).

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