[PP.27.14] PHEOCHROMOCYTOMA PRESENTED WITH ACUTE HEART FAILURE AND MULTIPLE ORGAN DAMAGE. (September 2017)

• Record Type: Journal Article
• Authors: Papadakis, I.; Velegraki, M.; Ioannou, P.; Theodorakopoulou, V.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523930.43751.c9
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Pheochromocytomas are catecholamine secreting tumors that provoke paroxysmal hypertensive crises. Design and method: We describe an atypical manifestation of pheochromocytoma in a patient presented with acute pulmonary edema and multiple organ dysfunction. Results: Case report: A 61-year-old woman with a medical history of hypothyroidism was admitted due to acute pyelonephritis. On day two, under antibiotic treatment, she developed acute pulmonary edema and severe left vertical (LV) systolic dysfunction (Ejection Fraction: 35%). Coronary angiography showed normal coronary arteries. She rapidly became hemodynamically unstable with multiple organ dysfunction, which was remitted during the next days. However, her blood pressure (BP) fluctuated from 180/105 to 200/115mmHg and she was treated with amlodipine, metoprolol and nitroglycerin. The new echocardiogram showed normal LV systolic function and concentric hypertrophy of LV walls. The BP levels were below 130/70mmHg without antihypertensive medication. Due to the suspicion of a pheochromocytoma an abdominal computed tomography was performed which revealed a right adrenal tumor of 4 × 2.7 cm. This finding was further supported by an abdominal MRI scan. The 24-hour urine collection revealed an elevation of total metanephrines. An I-123 MIBG scintigraphy was carried out showing selective uptake of MIBG by the right adrenal tumor, indicating that the tumor was probably a pheochromocytoma. The patient was started on doxazosin and is about to undergo a right adrenalectomy. Conclusions: Pheochromocytomas should be considered as part of the differential diagnosis in patients with symptoms suggestive of both Acute Heart Failure and multiple organ dysfunction.