Endocrine Abstracts

Background: Although pheochromocytoma classically presents with headaches, palpitations and paroxysmal hypertension, uncommon presentations such as cardiomyopathy, stroke and subarachnoid haemorrhage have been documented. We present one such infrequent presentation of myocardial infarction with normal coronary arteries (MINOCA).

Case presentation: A 79-year Caucasian female presented with central crushing chest pain radiating to left arm associated with headache, palpitations, sweating and difficulty in breathing. For two years, she experienced brief episodes of headache, tinnitus, dizziness, palpitations, and sweating that spontaneously resolved. Clinical examination was unremarkable except for high blood pressure (210/105 mmHg). Her electrocardiogram showed T wave inversions from V1-V6 and serum troponins were high (774 ng/l at baseline and 932 ng/l three hours from baseline). Following evaluation, patient was diagnosed with acute coronary syndrome. Coronary angiography showed normal coronary arteries. She was treated as MINOCA. During the in-patient hospital stay, patient continued to experience episodic headaches, palpitations, dizziness and erratic blood pressures. Further investigations revealed raised urine noradrenaline (4724 nmol/24 hr, reference <554 nmol/24 hr), urine adrenaline (92863 nmol/24 hr, reference <77 nmol/24 hr). Computerised tomography scan showed well-defined rounded mass in right adrenal gland, measuring 5 cm×3.7 cm×5 cm. Patient was diagnosed with pheochromocytoma and medically stabilized with alpha- and beta-adrenergic receptor blocker (doxazocin and bisoprolol). She was then referred to tertiary care hospital for tumour removal.

Conclusion: Through this case, we highlight the importance of thorough investigation for the underlying cause for MINOCA. In patients with unexplained erratic blood pressure control, pheochromocytoma should be considered as a differential diagnosis.