J Korean Soc Endocrinol.  2005 Jun;20(3):283-288. 10.3803/jkes.2005.20.3.283.

A Case of Pheochromocytoma Presented with Cardiogenic Shock

• Do MY
• Kim HM
• Ko YG
• Lim SK
• Jung JH
• Chung N
• Kim YA
• Kang SA
• Moon JH
• Lee JH
• Choi ST

• KMID: 2200570
• DOI: http://doi.org/10.3803/jkes.2005.20.3.283

Abstract

A pheochromocytoma is a catecholamine secreting tumor, which is often overlooked when cardiovascular complications, such as acute heart failure, myocardial infarction, angina pectoris, arrhythmias, and dilated cardiomyopathy, presented as the initial clinical manifestations. Failure to identify a pheochromocytoma in these situations may be fatal. We report the case of 32-year-old female, who presented with cardiogenic shock. Echocardiography revealed severe global hypokinesia of the dilated left ventricle, with the exception of the apex. Computed tomography of the aorta showed a well-enhanced left adrenal mass, 3.5cm in diameter. A 24 hour urine collection study for catecholamines and a 131I-metaiodobenzylguanidine(MIBG) scan were suggestive of the diagnosis of a single adrenal pheochromocytoma. The patient stabilized after shock management, and recovered with intensive medical treatment. Follow-up echocardiography revealed normalized cardiac function and chamber dimensions. Thereafter, the adrenal mass was successfully removed using laparaoscopic surgery, without complications

MeSH Terms

Adult
Angina Pectoris
Aorta
Arrhythmias, Cardiac
Cardiomyopathy, Dilated
Catecholamines
Diagnosis
Echocardiography
Female
Follow-Up Studies
Heart Failure
Heart Ventricles
Humans
Hypokinesia
Myocardial Infarction
Pheochromocytoma*
Shock
Shock, Cardiogenic*
Urine Specimen Collection
Catecholamines

Figure

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  Fig. 1 A. At the emergency room, chest X-ray shows acute bilateral pulmonary edema. B. After medical treatment, chest X-ray shows the disappearance of pulmonary edema.

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  Fig. 2 A. The initial echocardiography revealed the dilatation and hypokinesia of left ventricle. B. After recovery, follow-up echocardiography revealed the normal chamber and function of left ventricle

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  Fig. 3 Computed tomography revealed a well-circumscribed round mass in the left adrenal gland. (A: cross section, B: coronal section)

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  Fig. 4 I131 MIBG scan shows the single hot uptake at the left adrenal gland.

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  Fig. 5 Tumor cells have eosinophillic cytoplasm and polygonal shape, and are surrounded by mesenchyma of vasculature (H-E stain, A: ×200, B: ×400).

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