Pheochromocytoma: a cause of ST-segment elevation myocardial infarction, transient left ventricular dysfunction, and takotsubo cardiomyopathy.

[adrenal incidentaloma]

To report the case of a patient with a pheochromocytoma and apical left ventricular dysfunction that resolved after surgical resection of the pheochromocytoma , to review the effects of catecholamines on myocyte function and the concept that takotsubo cardiomyopathy (TC ) is caused by excess catecholamines , and to illustrate the difficulty in the management of an acute coronary syndrome (ACS ) during a hypertensive crisis attributable to a pheochromocytoma .We present the clinical history , physical findings , laboratory results , and imaging studies in a 60 -year -old man with an ACS , TC , and an incidentaloma later diagnosed to be a pheochromocytoma . The association with TC and the pertinent literature are reviewed .A 60 -year -old man was suspected of having myocardial ischemia on the basis of symptoms of paroxysmal chest pain extending to the left shoulder , diaphoresis , ST-segment elevation on an electrocardiogram , and elevated serial levels of cardiac enzymes . Coronary angiography did not reveal substantial coronary artery obstruction but detected ballooning of the apical , anterior , and inferior cardiac walls , consistent with TC . He had a history of labile hypertension and palpitations of 3 months ' duration . An adrenal mass detected on a prior computed tomographic scan and increased 24 -hour urine catecholamine levels were consistent with a pheochromocytoma . Treatment with phenoxybenzamine was initiated , and he underwent a right adrenalectomy , which confirmed that the tumor was a pheochromocytoma and dramatically improved the patient 's condition .Pheochromocytomas manifest with labile blood pressures and should be considered in the differential diagnosis of ACS . This case also supports the concept that TC is caused by excess catecholamines .

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adrenal incidentaloma

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