Unexpected triggers for pheochromocytoma-induced recurrent heart failure

Abstract

Pheochromocytoma crisis typically presents as paroxysmal episodes of headache, tachycardia, diaphoresis or hypertension. We describe an uncommon case of recurrent non-hypertensive heart failure with systolic dysfunction in a young female due to pheochromocytoma compression. It presented as acute pulmonary oedema while straining during pregnancy and later on as cardiogenic shock after a recreational body massage. Such crisis occurring during pregnancy is rare. Moreover, of the few reported cases of pheochromocytoma-induced cardiogenic shock, recreational body massage has not yet been reported as a trigger for this condition.

Pheochromocytoma, “the Great Masquerader,” Presenting as Severe Acute Decompensated Heart Failure in a Young Patient

“…Previous reports have showed that pheochromocytoma-induced cardiomyopathy can be reversed with medical therapy first followed by a subsequent tumor extirpation [ 4 , 6 – 9 ], as with our patient. The prognosis of catecholamine-induced cardiomyopathy depends on early diagnosis and prompt medical and surgical treatment.…”

Unexpected or Nonsuspected?

“…The clinical presentation is variable: hypertension is the most frequent (65%), and the classical triad (headache, palpitations, and diaphoresis) is described in 4% ( 1 ). There are few reports of patients who present cardiogenic shock ( 2 ), but the predominance of multiorgan failure over catecholamine excess symptoms is frequently described ( 1 ). In this case, dobutamine could contribute to the evolution because of its potential to induce shock in patients with pheochromocytoma ( 2 ).…”

“…There are few reports of patients who present cardiogenic shock ( 2 ), but the predominance of multiorgan failure over catecholamine excess symptoms is frequently described ( 1 ). In this case, dobutamine could contribute to the evolution because of its potential to induce shock in patients with pheochromocytoma ( 2 ). The pheochromocytoma resection is associated with improvement of ventricular function in 96% of cases.…”