Endocrine Abstracts

Introduction: Although pheochromocytoma with fatal myocardial infarction has been described over 50 years ago, diagnostics focused on catecholamine secretion is not a routine procedure post myocardial infarction.

Case report: A 49-year-old man, previously healthy, was admitted to the hospital in June 2003, with severe pulmonary oedema. Myocardial infarction was diagnosed on the basis of an increase in markers of myocardial necrosis. There was also found a significant hyperglycaemia and ketoacidosis. Coronary angiography, has not confirmed the changes in the vessels. Due to respiratory failure patient had to be mechanically ventilated. There was even a short-term cardiac arrest. After intensive treatment his status had improved and the patient left the hospital in a stable condition, require two antihypertensive drugs and insulin. In the following years (until 2012) patient has a six NSTEMI. In none of the subsequent coronary angiography important atherosclerotic lesions are visualised. The patient frequent suffered from angina and anxiety. In January 2012 in the left adrenal gland was found in the ultrasound focal lesion, confirmed in tomography as 34 mm high density lesion (50jH) with contrast retention. Hormonal diagnostics allowed diagnose adrenal pheochromocytoma. Surgery was delayed for seven and until now the last heart attack (07/05/2012). After the preparation of alpha-blocker, the patient was successfully operated on 05/09/2012. Removal of phaeochromocytoma resulted not only normalisation of blood pressure and the disappearance of the from the coronary symptoms but allowed the metabolic control and improve the patient’s mental state. Currently, the patient is at a good physical and mental condition, treated with a small dose of ramipril, nebivolol and metformin.

Conclusion: The diagnosis of phaeochromocytoma is difficult, although this may change substantially fate of people affected by them. An important clue may be inadequate response to typical treatment.