Endocrine Abstracts

Introduction: The acute onset of pulmonary edema and severe congestive heart failure secondary to catecholamine overproduction from a pheochromocytoma is a rare entity, especially in the absence of other signs or symptoms suspicious of this tumour. Myocardial involvement can include angina pectoris, acute heart failure, dilated cardiomyopathy, myocardial infartion and arrhytmias. Here, we present the case of a young man with no significant medical history who presented with acute pulmonary edema and dilated cardiomyophaty secondary to a unknown pheochromocytoma.

Case report: A 29-year-old caucasian male presented in the emergency room with an acute pulmonary edema, which resolved with minimal therapy; he had no cardiovascular risk factors (including hypertension), but he complained of palpitations and diaphoresis since 3 months ago. It was performed an echocardiogram which revealed a dilated cardiomyopathy with severe decline of systolic function. Twenty-four hour catecholamine and metanephrine levels were obtained: total metanephrine level of 6073 μg/24 h (normal value<1600), normetanephrine of 5197 μg/24 h (normal between 105 and 354), total catecholamine level of 1281 μg/24 h (217–575), noradrenaline of 958 μg/24 h (23–105). He was ordered an abdominal computed tomography, which revealed a 4.8×3.7 cm left adrenal mass. The patient was started on phenoxybenzamine (10 mg by mouth four times a day), and posteriorly with carvedilol (6.25 mg twice a day); 2 months later he underwent a laparoscopic left adrenalectomy with no complications. In the follow-up, it was verified a complete regression of the cardiomyopathy, with return to normal systolic function; he is currently doing well.

Discussion/Conclusion: Pheochromocytoma is a rare clinical entity and a diagnostic challenge, even more in this clinical setting; it should be included in the differential diagnosis of acute congestive heart failure when no other obvious cause can be elicited.