title: Cardiac failure due to epinephrine-secreting pheochromocytoma: clinical, laboratory and pathological findings in a sudden death.
abstract: A rare case of cardiac failure due to hypertensive crisis in pheochromocytoma in a 25-year-old young man is presented. In the Emergency Department the patient complained of persisting headache and vomiting; he was distressed but fully alert, his heart rate was 110 b/min and blood pressure 180/80 mmHg. Few hours after admission, the clinical course suddenly got worse with signs and symptoms of fatal cardiac shock (dyspnoea, cyanosis, pulmonary oedema, hypocontractility of left ventricle). Autopsy revealed a large tumour of the left adrenal gland. Histological examination confirmed macroscopic suspicion of pheochromocytoma. Catecholamine serum levels were analysed by high pressure liquid chromatography (HPLC) with electrochemical detection. The urine contained 35 microg/24 h norepinephrine and 184 microg/24 h epinephrine (normal range < or = 64 and < or = 36 microg/24 h respectively). These laboratory findings impressively demonstrate that the tumour was active, secreting high levels of epinephrine. Cardiac failure due to an acute catecholamine-related hypertensive crisis was established as the cause of death.
authors.affiliation: Department of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Viale degli Aviatori, no. 1, 71100 Foggia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: D'Errico
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Pomara
authors.forename: Irene
authors.initials: I
authors.lastname: Riezzo
authors.forename: Margherita
authors.initials: M
authors.lastname: Neri
authors.forename: Emanuela
authors.initials: E
authors.lastname: Turillazzi
authors.forename: Vittorio
authors.initials: V
authors.lastname: Fineschi
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D000328:Adult; D001344:Autopsy; D003645:Death, Sudden / Q000209:etiology / Q000473:pathology; D004837:Epinephrine / Q000097:blood / Q000378:metabolism / Q000652:urine; D017809:Fatal Outcome; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000209:etiology; D016365:Liability, Legal; D008297:Male; D010673:Pheochromocytoma / Q000150:complications* / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology
chemical_list: D004837:Epinephrine