Hearing the Hoofbeats of Pheochromocytoma in New-Onset Cardiomyopathy Leads to Success Instead of Failure

Pheochromocytoma is a rare cause of nonischemic cardiomyopathy with a variable clinical presentation. We report 2 cases in which the diagnosis of pheochromocytoma was not initially recognized during evaluation of a reduced left ventricular ejection fraction, despite some potential clues. Following diagnosis, largely driven by incidental detection of an adrenal mass, targeted treatment with surgical resections led to successful outcomes. One patient maintained left ventricular ejection fraction >55% for more than 15 years. These cases emphasize that in patients with new-onset nonischemic cardiomyopathy who have either a relapsing/remitting pattern of left ventricular ejection fraction or evidence of catecholamine excess, pheochromocytoma should be considered. With appropriate diagnosis and targeted treatment, successful and durable recovery of cardiac function is possible.