Septic Shock Precipitating a Pheochromocytoma Crisis: A Case of Sequential Acute Myocardial Infarction and Cardiogenic Shock

Pheochromocytomas are rare neuroendocrine tumors that can cause life-threatening cardiovascular complications due to excessive catecholamine secretion. We report an unusual case in which acute gastroenteritis served as the trigger for a severe pheochromocytoma crisis. A 64-year-old woman with a history of an undiagnosed left adrenal mass presented with a two-day history of nausea, vomiting, and diarrhea. She rapidly deteriorated into septic shock, requiring vasopressor support and hydrocortisone. Subsequently, she developed an acute myocardial infarction and heart failure. During hospitalization, she exhibited dramatic blood pressure fluctuations (60-220/40-110 mmHg), with paroxysmal hypertensive crises accompanied by the classic triad of palpitations, headache, and profuse sweating. Laboratory studies revealed markedly elevated plasma and urinary catecholamine levels. Abdominal computed tomography (CT) confirmed a 3.3 cm left adrenal mass, leading to the diagnosis of pheochromocytoma. This case underscores that common infections, such as acute gastroenteritis, can act as potent stressors to precipitate a pheochromocytoma crisis, resulting in a complex and life-threatening presentation including septic shock, cardiogenic shock, and acute myocardial infarction. Early recognition of this potential trigger and the underlying tumor is critical for guiding appropriate management and preventing catastrophic outcomes. Physicians should maintain a high index of suspicion for pheochromocytoma in patients with unexplained hemodynamic instability, even in the setting of a common infectious illness.