Clin Ultrasound.  2025 May;10(1):23-27. 10.18525/cu.2025.10.1.23.

A Case of Pheochromocytoma-induced Reverse Tako-Tsubo Cardiomyopathy: Insights from Multimodal Imaging

• Jeong JC
• Choi KU

• KMID: 2568255
• DOI: http://doi.org/10.18525/cu.2025.10.1.23

Abstract

A 50-year-old female with pheochromocytoma presented with chest pain and high blood pressure. Laboratory tests revealed elevated creatine kinase-MB (5.0 ng/mL), high-sensitivity troponin I (0.954 ng/mL), and N-terminal pro-B-type natriuretic peptide (238 pg/mL). Echocardiography revealed a left ventricular ejection fraction (LVEF) of 48% with regional wall motion abnormalities (RWMA) consistent with the reverse Tako-Tsubo pattern. Coronary angiography and ergonovine provocation test were unremarkable. Cardiac fluoro-deoxy-glucose positron emission tomography (PET)/magnetic resonance confirmed stress-induced cardiomyopathy (SCMP) with myocardial edema. Catecholamine levels were markedly elevated one month prior. Whole-body PET/computed tomography identified a hypermetabolic 3.8 cm left adrenal mass, consistent with pheochromocytoma. Follow-up echocardiography showed complete recovery of LVEF and RWMA. Reverse Tako-Tsubo, an atypical variant of SCMP, presents with basal hypokinesis and apical sparing, unrelated to coronary territory. This case emphasizes the importance of recognizing pheochromocytoma-induced SCMP and highlights the utility of multimodal imaging in its diagnosis and management.

Keyword

Stress cardiomyopathy; Pheochromocytoma; PET Imaging