Endocrine Abstracts

Case History: We present a case of a 33-year-old woman who attended with heart failure whilst awaiting a surgical resection of phaeochromocytoma. She presented hours after an intravenous iron transfusion to treat her known iron-deficiency anaemia secondary to menorrhagia from massive uterine fibroids, for which she under the care of the gynaecology team. She was known to have a right-sided phaeochromocytoma, which was found incidentally on MRI in 2021, and was taking phenoxybenzamine in preparation for surgical resection. The massive uterine fibroids were felt to complicate the surgical approach for a resection of her phaeochromocytoma, and as such a myomectomy was deemed necessary to facilitate the adrenalectomy. The combination of procedure complexity and frequent bouts of symptomatic anaemia requiring transfusions, resulted in a delay in her planned joint procedure. She had no other significant past medical history and as part of a pre-operative assessment in November 2021, she had had a transthoracic echocardiogram (TTE) which was normal. Her presenting symptoms included progressive breathlessness, dry cough, severe fatigue, and in contrast to her previous presentations with breathlessness from anaemia, she exhibited clinical features in keeping with fluid overload.

Investigations: Chest x-ray revealed bilateral perihilar shadowing and prominent pulmonary vasculature ECG showed sinus tachycardia. TTE revealed global left systolic dysfunction with an estimated ejection fraction <35%, left atrial and ventricular dilatation and high probability of pulmonary hypertension.

Results and Treatment: In view of the results above, a diagnosis of catecholamine-induced cardiomyopathy was made, and urgent endocrinology and cardiology reviews were sought. Initial medical management consisted of furosemide, bisoprolol and supplemental oxygen therapy. She was transferred to a rhythm-monitored area due to the risk of cardiac arrhythmias. Symptomatic improvement was observed, and a joint adrenalectomy and myomectomy was expedited.

Conclusions: This case highlights the importance of recognising this uncommon complication of phaeochromocytoma. It also emphasises the importance of comprehensive clinical assessment, including the physical examination, when patients present repeatedly. This patient had multiple attendances with breathlessness from her symptomatic anaemia and was treated appropriately with red blood cell and iron transfusions. However, on this occasion there were new features on examination to suggest a different aetiology that could have resulted in misdiagnosis if missed.