Endocrine Abstracts

Introduction: Pheochromocytomas are a rare catecholamine secreting tumours that can mimic numerous stress-associated disorders, such as Takotsubo cardiomyopathy, or transient left ventricular apical ballooning which is brought on by an acute coronary vasospasm due to an excessive sympathetic stimulation.

Case Report

A 68-year-old woman, with previous medical history of hypertension and type 2 diabetes, who was on 30 units of isuline glargine, 850 mg metformin, 10 mg amlodipine, and 100 mg losartan per day, complained of epigastric pain and nausea and was initially suspected of having myocardial ischemia. ST segment elevation were noted on EKG in leads V2 and V3, and elevated ultrasensitive troponin levels were found in the blood test. She underwent coronary angiography, which did not show significant artery obstruction but revealed severe systolic dysfunction and akinesis of the mid-anterior, anteroapical and inferoapical segments. Her condition worsened in the following 24 h, and a total body CT scan showed a 7 cm tumor in the left adrenal gland. Urinary, and plasmatic catecholamines and metanephrines were consistent with pheochromocytoma. Treatment with phenoxybenzamine was initiated, improving patient’s condition dramatically.

She underwent left adrenalectomy which confirmed that the tumor was indeed a pheochromocytoma. Three months after the surgery she is off medication for her diabetes and the cardiomyopathy has since resolved.

Conclusions: It is very important to consider Takotsubo in a patient presenting an acute coronary syndrome, and it is essential to rule out pheocromocytoma if such cardiomyopathy is suspected, because the early detection is crucial to the prognosis. The surgical resection of the adrenal mass might in most of the cases resolve the cardiomyopathy, and also prevent a fatal outcome due to a catecholamine crisis.