Pheochromocytoma

Ventricular tachycardia and raised troponin: “What if it’s a pheochromocytoma”? Some lessons from a crisis

Case Reports, Volume 20, Issue 4, Pages 249 – 308 (2021)

A 63-year-old female with cardiovascular risk factors presented with tremor, sweating, lower back discomfort, nausea and dyspnoea. Electrocardiogram showed sinus tachycardia with lateral ST-depression. High-sensitivity troponin-T was dynamically elevated (72ng/L to 112ng/L on one-hour repeat). Overnight, there was an episode of ventricular tachycardia with further troponin rise to 364ng/L. Coronary angiogram demonstrated non-obstructive coronary artery disease. Post-procedure, the patient developed a hypertensive crisis with pulmonary oedema (invasive blood pressure 350/140mmHg). This was managed with intravenous phentolamine. Ondansetron and metoclopramide were given for intractable vomiting. A pheochromocytoma was subsequently confirmed and surgically excised. Our experience in this case generated several important learning points that we hope may be of benefit to others who encounter suspected pheochromocytomas on the acute medical take.

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Pheochromocytoma presenting as a mimic of acute coronary syndrome

Case Reports, Volume 15, Issue 3, Pages 109 – 164 (2016)

Abstract

Chest pain with elevated serum troponin is a common clinical presentation and is normally managed as suspected myocardial infarction or acute coronary syndrome (ACS). We report a 49 year old man who presented with central chest pain sweating and breathlessness. He had a significantly elevated serum troponin I level and a subsequent angiogram showed near normal coronary arteries. He was subsequently investigated for fever and found to have a 3cm right sided adrenal mass consistent with a pheochromocytoma. After confirmation and appropriate blockade laparoscopic adrenalectomy was performed.
Pheochromocytoma may present as a mimic of acute coronary syndrome but this is often unrecognized and leaves the patient at risk of future pheo crisis events which may be fatal.

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