title: Portal vein thrombus and liver failure in a patient with pheochromocytoma crisis.
abstract: A 51-year-old man with known pheochromocytoma refused surgical treatment over several years and subsequently presented in catecholamine crisis with shock and multiple organ failure. Laboratory testing revealed liver failure with elevated liver enzymes and coagulation abnormalities, and imaging showed ischemia of extended parts of the right liver lobe. It also revealed a large thrombus in the right portal vein, which together with severe arterial vasoconstriction impaired the dual blood supply of the liver. The patient recovered after effective medical treatment and finally underwent surgical tumor resection. Thereafter, antihypertensive treatment could be stopped. We present this exceptional case of adrenal crisis and discuss the mechanisms leading to liver failure in general and portal vein thrombosis in particular.
authors.affiliation: Medical Intensive Care Unit, University Hospital Zurich, CH 8091 Zurich, Switzerland.
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Brauchlin
authors.forename: Alain
authors.initials: A
authors.lastname: Rudiger
authors.forename: Esther B
authors.initials: EB
authors.lastname: Bächli
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid
authors.forename: Marco
authors.initials: M
authors.lastname: Maggiorini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications*; D011169:Portal Vein; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy