Pheochromocytoma presenting as life-threatening pulmonary edema.
Acute cardiogenic pulmonary edema as the first presentation of pheochromocytoma is uncommon and usually rapidly fatal. A 39-yr-old man presented in acute cardiogenic shock with global ventricular dysfunction that required high-dose iv inotrope support and an intraaortic balloon pump assist device. Abdominal imaging to exclude aortic dissection revealed a 6-cm right adrenal mass. Significant myocardial infarction (electrocardiographic changes and elevated cardiac enzymes) contributed to the cardiac decompensation. After withdrawal of inotrope support, 24-h urinary catecholamine levels revealed 2,155 nmol/d (<125) of adrenaline and 7,437 nmol/d (<560) of noradrenaline, confirming a pheochromocytoma. The tumor was successfully removed at laparotomy; however, the patient's course was complicated by a thromboembolic cerebrovascular accident with paraplegia. He recovered cardiac function almost completely within 3 wk of medical therapy alone. Although uncommon, this case highlights the need to consider pheochromocytoma early in the management of unexplained cardiogenic shock.
Kaye
J
J
Department of Endocrinology and Diabetes, Royal Perth Hospital, Western Australia, Australia.
Edlin
S
S
Thompson
I
I
Leedma
P J
PJ
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D004562:Electrocardiography; D004837:Epinephrine / Q000652:urine; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology; D009638:Norepinephrine / Q000652:urine; D010264:Paraplegia / Q000150:complications; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D011654:Pulmonary Edema / Q000209:etiology*; D012770:Shock, Cardiogenic / Q000209:etiology*; D020521:Stroke / Q000150:complications; D013923:Thromboembolism / Q000150:complications
D009638:Norepinephrine; D004837:Epinephrine