Endocrine Abstracts

Phaeochromocytoma crisis is a rare life-threatening emergency and a diagnostic challenge.
Over a 5 year period four patients (2 male, mean age of 38.5 years, range 29-51 years) presented to our intensive care unit with unexplained severe cardiopulmonary dysfunction. Other clinical features included pulmonary infiltrates (4/4), vomiting (3/4), palpitations (2/4), breathlessness (4/4), acute renal failure (2/4), fever (1/4) and abdominal discomfort (1/4). Hypertension was present only in 1 patient at the time of admission. An initial diagnosis of cardiomyopathy was made in 3 patients and severe atypical pneumonia leading to myocarditis in one patient. All patients received high flow oxygen, antibiotics and initial inotropic support. Two patients had received beta blockers for hypertension in the community shortly before the onset of their illness, and one other patient's condition deteriorated during the ITU admission after initiation of beta blockade for control of cardiac dysfunction. All four patients made a complete recovery and underwent successful adrenalectomy. Unexplained severe cardiopulmonary dysfunction, particularly after the institution of beta blockade should alert clinicians to the possibility of a phaeochromocytoma.