Phaeochromocytoma mimicking acute ST-elevation myocardial infarction

Abstract

Phaeochromocytomas are rare catecholamine-secreting tumours, usually benign, originating from chromaffin cells of the adrenal glands. Their typical presentation includes the triad of headaches, sweating and tachycardia due to excessive catecholamine release. However, many patients do not exhibit all three symptoms, making diagnosis challenging. A significant proportion of cases (around 40%) are linked to genetic disorders. Cardiac complications, including life-threatening events, are common.This report details the case of a 43-year-old woman presenting with chest pain, headaches and diaphoresis. Initial ECG showed an anterolateral ST-elevation myocardial infarction pattern, but coronary angiography revealed no arterial disease. The left ventricular angiogram indicated apical ballooning. Elevated blood pressure prompted suspicion of phaeochromocytoma, which was confirmed through positive metanephrine tests.The tumour, located in the right adrenal gland, was successfully removed laparoscopically, and pathological examination confirmed the diagnosis.Phaeochromocytoma should be suspected in patients with unexplained myocardial infarction, labile hypertension and normal coronary arteries, as beta-blockers can be harmful if used in untreated cases.