[Cardiogenic shock in a 61 year old female with recurrent panic attacks].
A 61 year old patient in a severely reduced general condition complaining of epigastric pain was admitted to our emergency room. Because of elevated troponin T and creatine kinase levels and severely reduced left ventricular function as seen in echocardiography as well as negative T-waves in the anterolateral ECG leads we suspected an acute coronary syndrome. The patient underwent coronary angiography after intubation and a coronary artery disease was excluded. The initial therapy included the use of an intraaortic balloon pump, volume and catecholamine administration controlled by a pulmonary artery catheter. Conducting an abdominal ultrasound we detected a mass at the right adrenal gland. The suspected diagnosis of pheochromocytoma was confirmed by elevated catecholamine levels in the urine and a CT scan. After recompensation and subsequent administration of phenoxybenzamine a benign pheochromocytoma was resected. A massive catecholamine secretion due to a pheochromocytoma can lead to a cardiogenic shock and multiple organ failure. In patients with recurrent panic attacks and hypertension a pheochromocytoma should be included in the differential diagnosis.
Mischke
K
K
Medizinische Klinik I, Universitätsklinikum Aachen. kmischke@ukaachen.de
Graf
J
J
Rulands
D
D
Koch
K C
KC
Hanrath
P
P
Janssens
U
U
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D055502:Secondary Prevention; D012770:Shock, Cardiogenic / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*