Citation Information :
Faridi SH, Harris SH, Afrose R, Siddiqui B, Ashraf H. Bilateral Pheochromocytoma: An Atypical Cause of Myocardial Infarction in a Young Male. World J Endoc Surg 2021; 13 (2):64-67.
Aim: To describe a rare case of bilateral pheochromocytoma in a young male presenting with two episodes of myocardial infarction.
Background: Pheochromocytoma is a catecholamine-producing tumor which arises from the adrenal medulla or rarely from an extra-adrenal site. It may present with a wide range of clinical symptoms and signs, ranging from headache, palpitations, and paroxysmal hypertension to rare events such as cardiomyopathy, cardiogenic shock, seizures, and intracranial bleeding.
Case description: We report a case of a 39-year-old male who presented to us with complaint of pain abdomen, palpitation, episodic headache, and shortness of breath for last 1 year. He also had history of two episodes of myocardial infarction during the last 9 months. After careful history, examination and investigations he was diagnosed as a case of bilateral functional adrenal pheochromocytoma with secondary cardiomyopathy. Bilateral open transperitoneal adrenalectomy was done and patient improved symptomatically. Histopathology of the specimen confirmed the diagnosis of bilateral benign pheochromocytma. Owing to this rare presentation of a very rare tumor this case is being reported here.
Conclusion: Functional pheochromocytoma rarely presents with cardiomyopathy and myocardial infarction. There should be a high level of suspicion if a young patient presents with myocardial infarction in the normal coronary angiography.
Clinical significance: This case illustrates an uncommon presentation of pheochromocytoma presenting with two episodes of myocardial infarction in a young man with normal coronary angiography. A high suspicion index for pheochromocytoma is required in such cases.
Manger WM. An overview of pheochromocytoma: history, current concepts, vagaries, and diagnostic challenges. Ann N Y Acad Sci 2006;1073:1–20. DOI: 10.1196/annals.1353.001
van Oordt CWMH, Twickler TB, van Asperdt FGMH, et al. Pheochromocytoma mimicking an acute myocardial infarction Neth Heart J 2007;15(7-8):248–251. DOI: 10.1007/BF03085991
Beedupalli J, Akkus NI. Concealed pheochromocytoma presenting as recurrent acute coronary syndrome with STEMI: case report of a patient with hyperthyroidism. Herz 2014;39(4):476–480. DOI: 10.1007/s00059-013-3826-y
Bloom S. Catecholamine cardiomyopathy. N Engl J Med 1987;317(14):900–901. DOI: 10.1056/NEJM198710013171413
O’Connor DT. The adrenal medulla, catecholamines, and phaeochromocytoma. In: Cecil RL, Goldman L, Ausiello DA, editors. Cecil's Textbook of Medicine. Philadelphia, PA: Saunders; 2003.1419–1424.
Ajallé R, Plouin PF, Pacak K, et al. Treatment of malignant pheochromocytoma. Horm Metab Res 2009;41(9):687–696. DOI: 10.1055/s-0029-1231025
Lenders JWM, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet 2005;366(9486):665–675. DOI: 10.1016/S0140-6736(05)67139-5
Schurmeyer TH, Engeroff B, Dralle H, et al. Cardiological effects of catecholamine-secreting tumours. Eur J Clin Invest 1997;27(3):189–195. DOI: 10.1046/j.1365-2362.1997.850646.x
Werbel SS, Ober KP. Pheochromocytoma: update on diagnosis, localization and management. Med Clin North Am 1995;79(1):131–153. DOI: 10.1016/s0025-7125(16)30088-8
Nanda AS, Feldman A, Liang CS. Acute reversal of pheochromocytoma-induced catecholamine cardiomyopathy. Clin Cardiol 1995;18(7):421–423. DOI: 10.1002/clc.4960180712
Irwin Klein. Endocrine disorders and cardiovascular disease. In:, Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald Eeds. Braunwald's Heart disease: a textbook of cardiovascular medicine.9th ed. Elsevier Saunders Company 2012;1829–1843.
Communal C, Singh K, Pimentel DR, et al. Norepinephrine stimulates apoptosis in adult rat ventricular myocytes by activation of the _beta -adrenergic pathway Circulation 1998; 98(13):1329–1334. DOI: 10.1161/01.cir.98.13.1329
Babinska A, Peksa R, Sworczak K. Primary malignant lymphoma combined with clinically “silent” pheochromocytoma in the same adrenal gland. World J Surg Oncol 2015;13:289. DOI: 10.1186/s12957-015-0711-6, indexed in PubMed: 26419235.
Januszewicz W, Prejbisz A, Januszewicz A, et al. Pheochromocytoma— disease that can stimulate many different syndromes Nadciśnienie Tętnicze 2002;6(3):217–228.
Gimm O, Duh QY. Training in adrenal surgery faces many but solvable challenges. Gland Surg 2019;8(Suppl 1):S3-S9. DOI: 10.21037/gs.2019.01.08