Incidental Pheochromocytoma Induced Cardiogenic Shock. Case Report [Conference Winner Abstract]

Introduction Pheochromocytomas are usually diagnosed incidentally or during surveillance screening in individuals with a family history of the tumors. (1) Undiagnosed pheochromocytomas can significantly increase patient mortality if not detected early. (2) Case Presentation A 46-year-old male presented with complaints of nausea, chest pain, and general weakness. The patient was hospitalised to the intensive care unit, where he was diagnosed with inferior wall ST-segment elevation myocardial infarction along with heart failure and pulmonary edema. Percutaneous coronary intervention revealed thrombosis in the distal branches of the right coronary artery and normal left coronary vessels. The thrombus was aspirated and intra-aortic balloon counterpulsation was initiated. However, the patient remained severely desaturated, hypotensive and tachycardic. He experienced clinical death but was successfully resuscitated after 15 minutes of using the asystole algorithm. Following the patient’s rapid clinical deterioration, a cardiac echocardiogram was performed. It revealed an ejection fraction of 20% in the left ventricle (LF), with signs of dilated cardiomyopathy and impaired LF contraction. These findings along with patient’s clinical history of hypertensive episodes and panic attacks, raised suspicion of a pheochromocytoma induced cardiomyopathy. Consequently, an abdominal ultrasonography identified a 7.18 × 6.5 cm tumor in the right adrenal gland with signs of hemorrhagic collapse. After patient’s preparation with neurohormonal blockade and doxazosin, the tumor was surgically removed, histologically confirmed as a pheochromocytoma, and the patient recovered successfully. Discussion Key clinical findings that help in diagnosing pheochromocytoma-induced cardiogenic shock (PICS) include pulmonary congestion (83.3%), cyclic blood pressure fluctuations followed by hemodynamic deterioration (72.2%), chest pain, or the typical triad of symptoms: headache, sweating and palpitation. (3) Conclusions This case highlights the importance of thorough anamnesis collection, close patient monitoring and effective differential diagnosis for an early recognition and successful management of PICS, particularly when comorbid cardiological pathologies are present.