Successful extracorporeal membrane oxygenation resuscitation of patient with cardiogenic shock induced by phaeochromocytoma crisis mimicking hyperthyroidism: A case report

Abstract

A 29-year-old woman presented to the emergency department with the acute onset of palpitations, shortness of breath, and haemoptysis. She reported having an abortion (56 days of pregnancy) 1 week before admission because of hyperthyroidism diagnosis during pregnancy. The first diagnoses considered were cardiomyopathy associated with hyperthyroidism, acute left ventricular failure, and hyperthyroidism crisis. The young woman’s cardiocirculatory system collapsed within several hours. Hence, venoarterial extracorporeal membrane oxygenation (VA ECMO) was performed for this patient. Over the next 3 days after ECMO was established, repeat transthoracic echocardiography showed gradual improvements in biventricular function, and later the patient recovered almost completely. The patient’s blood pressure increased to 230/130 mm Hg when the ECMO catheter was removed, and then the diagnosis of phaeochromocytoma was suspected. Computed tomography showed a left suprarenal tumour. The tumour size was 5.8 cm × 5.7 cm with central necrosis. The vanillylmandelic acid concentration was 63.15 mg/24 h. Post-operation, pathology confirmed phaeochromocytoma. To our knowledge, this is the first case report of a patient with cardiogenic shock induced by phaeochromocytoma crisis mimicking hyperthyroidism which was successfully resuscitated by VA ECMO.

Pheochromocytoma crisis with refractory Acute Respiratory Distress Syndrome (ARDS), Takotsubo syndrome, emergency adrenalectomy, and need for Extracorporeal Membrane Oxygenation (ECMO) in a previously undiagnosed and asymptomatic patient, due to the use of metoclopramide

“…VA-ECMO was used in PCC crisis with severe cardiogenic shock, adrenal resection was performed after hemodynamic stability, and VA-ECMO was removed [ 28 , 29 ]. However, delayed surgery also increases the risk of recurrent crisis and multi-organ dysfunction, which can be fatal once the disease occurs at this stage.…”

Successful Use of Extracorporeal Life Support and Continuous Renal Replacement Therapy in the Treatment of Cardiogenic Shock Induced by Tumor Lysis Syndrome in a Pediatric Patient With Lymphoma: A Case Report

“…ECMO was weaned soon after surgery without any serious complications (11). Although there have been no rigorous large-scale clinical studies on the topic, a large number of successful cases of ECMO have been reported in cancer patients, which suggests that ECMO may be a rare emerging strategy for the treatment of obstructive shock caused by a primary mediastinal malignancy (12)(13)(14).…”

“…In addition, several cases of secondary circulatory crises in patients with pheochromocytoma have been reported along with a summary of cases that used VA-ECMO transitional support therapy ( 13 , 17 , 18 ). Severe respiratory and circulatory failure due to chemotherapy drug-related cardiopulmonary injuries can also require ECMO support.…”