25: Bridging the Unknown - ECMO as a Bridge to Diagnosis of Pheochromocytoma with Multisystemic Crisis: A Case Report

Background: Pheochromocytoma multisystem crisis is a rare, life-threatening emergency marked by severe catecholamine release and multi-organ dysfunction. Diagnosis is often delayed due to variable presentations, particularly with paroxysmal secretion. We present a case of pheochromocytoma crisis with paroxysmal release pattern, manifesting as multi-organ failure and requiring ECMO as bridge to diagnosis and recovery. Case Presentation: A 25-year-old man was referred from hospital following rapid decline in his condition after initial presentation with chest pain and vomiting, which were managed symptomatically. Upon evaluation, he was diagnosed with rapidly progressive acute lung injury, cardiogenic shock with an ejection fraction of 30%, disseminated intravascular coagulation, acute kidney injury, hepatitis, encephalopathy, and a small subdural hematoma. Owing to the rapid decline in pulmonary function, the patient was commenced on anticoagulation-free VV ECMO using sweep NO. The patient exhibited a rapid improvement in organ function and was decannulated on day 4 and extubated on day 5. Subsequently, he was evaluated for systemic causes of rapid-onset multiple organ failure. The only notable finding was a history of anxiety and palpitations on multiple anxiety medications. Initial assessments showed normal metanephrine and normetanephrine levels, while CECT abdomen suggested a heterogeneous enhancing mass adjacent to the right adrenal gland, consistent with pheochromocytoma. Reassessment following a paroxysmal event revealed elevated metanephrines and normetanephrines, with negative genetic testing for germline mutations, leading to a diagnosis of Sporadic pheochromocytoma with multisystem crisis characterized by paroxysmal release pattern and adrenergic phenotype. After adequate α- and β-blockade, the patient underwent successful adrenalectomy and a post operative PET scan was also not suggestive of any metastasis. Conclusion: This case underscores the successful use of ECMO as bridge to diagnosis in patient with pheochromocytoma-induced multisystem crisis. ECMO offers a vital window to uncover and manage rare but reversible causes like pheochromocytoma crisis.