title: Pheochromocytoma presenting as takotsubo-like cardiomyopathy following delivery.
abstract: OBJECTIVE
  Diagnosis of pheochromocytoma during pregnancy can be difficult, and the tumor carries an unfavorable prognosis if not diagnosed and treated in a timely manner.
  
  
  METHODS
  To present a case of Takotsubo-like cardiomyopathy characterized by transient left ventricular apical ballooning due to pheochromocytoma following delivery.
  
  
  RESULTS
  A few hours after Caesarean section, a 32-year-old Caucasian female presented with pulmonary edema followed by cardiac arrest with echocardiographic and ventriculographic evidence of reversible acute myocardial failure characteristic of Takotsubo-like cardiomyopathy. A previously unrecognized adrenal pheochromocytoma was found during her clinical work-up. Left ventricle (LV) function normalized after surgical removal of the tumor, which was carried out after implementing an alpha-adrenoreceptor blockade. Hemorrhagic necrosis of the pheochromocytoma was seen on histopathologic analysis; this may have triggered the sequence of events leading to the development of Takotsubo-like cardiomyopathy and hemodynamic collapse.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first reported case of Takotsubo-like cardiomyopathy related to pheochromocytoma following delivery. This emphasizes the increased cardiovascular risk if pheochromocytoma is not diagnosed and treated in a timely manner, especially during pregnancy.
authors.affiliation: Department of Hypertension, Institute of Cardiology, Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Jóźwik-Plebanek
authors.affiliation: Department of Hypertension, Institute of Cardiology, Warsaw, Poland.
authors.forename: Mariola
authors.initials: M
authors.lastname: Pęczkowska
authors.affiliation: Department of Congenital Heart Disease, Institute of Cardiology, Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Klisiewicz
authors.affiliation: Division of Internal Medicine and Diabetology, City Hospital, Włocławek, Poland.
authors.forename: Kazimierz
authors.initials: K
authors.lastname: Wrzesiński
authors.affiliation: Department of Hypertension, Institute of Cardiology, Warsaw, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Prejbisz
authors.affiliation: Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland Neurological Department, Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Niewada
authors.affiliation: Department of Hypertension, Institute of Cardiology, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Kabat
authors.affiliation: Department of Molecular Biology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Szperl
authors.affiliation: Institute of Laboratory Medicine & Clinical Chemistry and Department of Internal Medicine III, University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: Graeme
authors.initials: G
authors.lastname: Eisenhofer
authors.affiliation: Institute of Laboratory Medicine & Clinical Chemistry and Department of Internal Medicine III, University Hospital, Technische Universität Dresden, Dresden, Germany Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Jacques W
authors.initials: JW
authors.lastname: Lenders
authors.affiliation: Department of Hypertension, Institute of Cardiology, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz