Acute Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation Secondary to Catecholamine-Secreting Paraganglioma: A Case Report

A previously healthy 16-year-old female presented with acute onset of signs and symptoms of headache, nausea, sweating, abdominal pain, palpitations, chest pain, hypertension, and tachycardia. The patient was admitted to the pediatric critical care unit and rapidly progressed to cardiorespiratory failure, necessitating veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a life-saving measure. After three days of ECMO support, complicated by arterial thrombi to the left lower limb, necessitating below-knee amputation, the patient was weaned off ECMO and ventilator support. A renal ultrasound was performed, as the patient had significant hypertension, which revealed a left para-renal mass. A biopsy of the mass, elevated plasma/urine catecholamine, and genetic testing confirmed the diagnosis of paraganglioma-pheochromocytoma (PG-PH) syndrome. A diagnosis of PG/PH was made, and a catecholamine surge due to the tumor was deemed the cause of the cardiac arrest. This is a rare disease, and a presentation with cardiorespiratory arrest has not been reported in children prior to this case. Our case highlights the importance of early identification of rare cases using history and examination, along with screening of those at high risk. It also shines a light on the importance of VA ECMO support in severe cases that present with cardiac arrest.