title: Transient cardiogenic shock during a crisis of pheochromocytoma triggered by high-dose exogenous corticosteroids.
abstract: We report a case of a 39-year-old woman who presented to the emergency department (ED) with symptoms of pharyngitis and fever. Diagnosed with streptococcal pharyngitis, she received antibiotics and dexamethasone, and was discharged. Within 24 h she returned to the ED with signs and symptoms of an acute coronary syndrome; she was thus given β-blockers. Her coronary angiogram was normal. She developed cardiogenic shock with an ejection fraction (EF) of 10% and apical ballooning on echocardiography. Her condition improved with optimal medical therapy. Subsequent testing weeks later confirmed the presence of a pheochromocytoma. Following prazosin and an adrenalectomy, all her antihypertensive medications were weaned and her EF normalised. We believe the high-dose exogenous corticosteroids triggered a pheochromocytoma crisis. The concomitant use of β-blockers without preceding α blockade resulted in cardiovascular collapse. Pheochromocytoma crisis must be included in the differential diagnosis of any dramatic haemodynamic collapse after administration of exogenous corticosteroid or β-blockers.
authors.affiliation: Department of Internal Medicine/Division of Cardiology, University of Illinois College of Medicine at Peoria/OSF Saint Francis Medical Center, Peoria, Illinois, USA.
authors.forename: Majd
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Department of Internal Medicine/Division of Cardiology, University of Illinois College of Medicine at Peoria/OSF Saint Francis Medical Center, Peoria, Illinois, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Banga
authors.affiliation: Department of Internal Medicine/Division of Cardiology, University of Illinois College of Medicine at Peoria/OSF Saint Francis Medical Center, Peoria, Illinois, USA.
authors.forename: Suneetha
authors.initials: S
authors.lastname: Venkatapuram
authors.affiliation: Department of Internal Medicine/Division of Cardiology, University of Illinois College of Medicine at Peoria/OSF Saint Francis Medical Center, Peoria, Illinois, USA.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Mungee
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000315:Adrenalectomy; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000328:Adult; D003907:Dexamethasone / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D010612:Pharyngitis / Q000150:complications / Q000188:drug therapy; D010673:Pheochromocytoma / Q000139:chemically induced / Q000150:complications*; D012770:Shock, Cardiogenic / Q000209:etiology*
chemical_list: D000305:Adrenal Cortex Hormones; D000319:Adrenergic beta-Antagonists; D005938:Glucocorticoids; D003907:Dexamethasone