Phaeochromocytoma presenting as an acute coronary syndrome

Abstract

A 44-year-old Caucasian man presented to the emergency department in acute cardiogenic shock, with pulmonary oedema, secondary to an acute myocardial infarction and in a hyperosmolar hyperglycaemic state. The previous day he had undergone a colonoscopy, which revealed features of colitis, and was started on prednisolone. He had been previously diagnosed with type 2 diabetes, migraine and anxiety attacks. While awaiting a coronary angiogram he developed abdominal pain and a CT scan was performed and found a large right adrenal mass. Plasma-free metadrenaline levels were elevated. After 4 months, a right adrenalectomy was performed successfully. He made a good recovery with normalisation of his heart function and resolution of his diabetes. The diagnosis was delayed for years due to his episodic symptoms being attributed to other more common diagnoses. Although a rare diagnosis in itself, there are case reports of phaeochromocytoma initially presenting with an acute coronary syndrome.

Pheochromocytoma as a cause of repeated acute myocardial infarctions, heart failure, and transient erythrocytosis: A case report and review of the literature

“…The coronary angiogram showed nonobstructed coronary arteries. We noted that most of such patients had few significant coronary atherosclerosis in past reports[ 8 - 10 ]. Most reports suggested that cardiomyopathy, severe coronary vasospasm, myocarditis, and tachycardia caused by excessive release of catecholamines result in elevated cardiac troponin and reduced left ventricular systolic function[ 11 , 12 ].…”

Myocardial Infarction with non-obstructed coronaries – atypical presentation of pheochromocytoma

“…These tumours release rapid and massive amount of catecholamines that can cause life-threatening cardioand cerebrovascular complications (3). Data in 2012 showed 19.3% subjects with pheochromocytoma had a relatively high incidence of cardiovascular complications.…”