Treatment of pheochromocytoma crisis and median arcuate ligament syndrome with norepinephrine stabilized BP without recurrence post-surgery in a 45-year-old woman after 6 months.
Delayed surgical resection after medical stabilization with norepinephrine and alpha-blockers is safe and effective for managing a rare combination of pheochromocytoma crisis and median arcuate ligament syndrome.
Absolute Event Rate: 0% vs 0%
Rationale: Left ventricular thrombus caused by acute catecholamine cardiomyopathy combined with pheochromocytoma crisis (PC) is extremely rare in clinical practice, and there are no reports of patients with median arcuate ligament syndrome (MALS) at the same time. This report describes the case of a 45-year-old woman admitted to the cardiology department with this rare condition. The patient presented with severe abdominal pain, vomiting, rapid blood pressure (BP) fluctuations, and recurrent hypotensive syncope. We discuss the patient’s diagnosis and treatment and share our experience with this patient. Patient concerns: A combination of PC and MALS has not been previously reported. This successful treatment provides a reference for the future treatment of similar patients, filling a related gap. The treatment methods and outcomes are the most important aspects of patient care. Diagnoses: The patient was admitted to the hospital because of chest tightness, headache, abdominal pain, and several episodes of syncope for 4 days. Clinical symptoms, combined with enhanced chest-abdominal computed tomography, 24-hour ambulatory BP monitoring, left and right coronary angiography, and renin-angiotensin-aldosterone and adrenocorticotropic hormone-cortisol measurements, led to a diagnosis of catecholamine cardiomyopathy, PC, and MALS. Interventions: Continuous invasive arterial and venous BP monitoring, norepinephrine was administered via an intravenous pump, and intravenous crystalloid infusions were administered to improve the patient’s significant BP fluctuations. Subsequently, after a gradual improvement in BP fluctuations, an alpha receptor blocker (phenoxybenzamine) was administered orally, and the dose was gradually increased to the target dose to control BP. Finally, after 6 months of optimized medical treatment, the right adrenal tumor was safely resected with complete recovery of cardiac structure and function. Outcomes: During the 6-month follow-up, after the operation, the patient’s BP was stable without medication, hypotensive syncope, recurrence of abdominal pain, and tumor recurrence. Key laboratory test results, such as cardiac Troponin I, N-terminal pro-B-type natriuretic peptide, white blood cell, adrenocorticotropic hormone, cortisol, etc, returned to normal levels Lessons: First, it highlights the effectiveness of norepinephrine in treating BP fluctuations and hypotensive syncope in patients with pheochromocytoma. Second, we propose a potential pathological interaction between pheochromocytoma and MALS, thereby avoiding surgical treatment of MALS. Third, it confirmed the safety of delayed surgery in patients with high-risk cardiac conditions.
Wen et al. (Fri,) reported a other. Treatment of pheochromocytoma crisis and median arcuate ligament syndrome with norepinephrine stabilized BP without recurrence post-surgery in a 45-year-old woman after 6 months.