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Do, Kim, Ko, Lim, Jung, Chung, Kim, Kang, Moon, Lee, and Choi: A Case of Pheochromocytoma Presented with Cardiogenic Shock
Case Report
Journal of Korean Society of Endocrinology

Journal of Korean Society of Endocrinology 2005; 20(3): 283-288.

Published online: 30 June 2005

DOI: https://doi.org/10.3803/jkes.2005.20.3.283

A Case of Pheochromocytoma Presented with Cardiogenic Shock

Mi Young Do, Hee Man Kim, Young-Guk Ko, Sung Kil Lim, Jae-Hun Jung, Namsik Chung, Yeon-A Kim, Shin Ae Kang, Jae Hoon Moon, Jin Hyung Lee, Sang-Tae Choi

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Received 17 November 2004       Accepted 28 March 2005

Copyright © 2005 Korean Endocrine Society

Abstract

A pheochromocytoma is a catecholamine secreting tumor, which is often overlooked when cardiovascular complications, such as acute heart failure, myocardial infarction, angina pectoris, arrhythmias, and dilated cardiomyopathy, presented as the initial clinical manifestations. Failure to identify a pheochromocytoma in these situations may be fatal.
We report the case of 32-year-old female, who presented with cardiogenic shock. Echocardiography revealed severe global hypokinesia of the dilated left ventricle, with the exception of the apex. Computed tomography of the aorta showed a well-enhanced left adrenal mass, 3.5 cm in diameter. A 24 hour urine collection study for catecholamines and a 131I-metaiodobenzylguanidine (MIBG) scan were suggestive of the diagnosis of a single adrenal pheochromocytoma. The patient stabilized after shock management, and recovered with intensive medical treatment. Follow-up echocardiography revealed normalized cardiac function and chamber dimensions. Thereafter, the adrenal mass was successfully removed using laparaoscopic surgery, without complications.

Keywords: Pheochromocytoma, Cardiogenic shock, Catecholamine-induced cardiomyopathy

Figures and Tables

Fig. 1
A. At the emergency room, chest X-ray shows acute bilateral pulmonary edema.
B. After medical treatment, chest X-ray shows the disappearance of pulmonary edema.
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Fig. 2
A. The initial echocardiography revealed the dilatation and hypokinesia of left ventricle.
B. After recovery, follow-up echocardiography revealed the normal chamber and function of left ventricle
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Fig. 3
Computed tomography revealed a well-circumscribed round mass in the left adrenal gland. (A: cross section, B: coronal section)
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Fig. 4
I131 MIBG scan shows the single hot uptake at the left adrenal gland.
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Fig. 5
Tumor cells have eosinophillic cytoplasm and polygonal shape, and are surrounded by mesenchyma of vasculature (H-E stain, A: ×200, B: ×400).
jkse-20-283-g005
Table 1
The Reports of Cardiogenic Shock in Pheochromocytoma in the Korean and English Literature
jkse-20-283-i001

*PCPS: percutaneous cardiopulmonary support, IABP: Intraaortic balloon counter pulsation

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