Myocarditis revealing a pheochromocytoma: When the heart gives the adrenal gland away

Introduction: Pheochromocytoma is a rare tumour that secretes catecholamines and can present with a variety of complications, including severe cardiovascular complications such as myocarditis and cardiomyopathy. Early diagnosis of these atypical presentations is essential for prompt management. Case report: We report the case of a 62-year-old patient, a chronic smoker, admitted for management of a deterioration in his general condition. He presented with asthenia, weight loss, sweating, palpitations, headaches, abdominal pain and vomiting. Clinical examination revealed a hypertensive crisis (250/130 mmHg), tachycardia, proximal muscle weakness and abnormalities on the electrocardiogram. Laboratory tests revealed an infectious syndrome, acute renal failure and elevated cardiac biomarkers. Plasma methoxylated derivatives were very high. Imaging showed a left adrenal mass with central necrosis. The diagnosis was severe myocarditis with rhabdomyolysis secondary to a pheochromocytoma. Management involved antihypertensive treatment, antibiotic therapy and plans for adrenal surgery. Conclusion: This case highlights the importance of considering pheochromocytoma in the presence of cardiac symptoms that may sometimes be atypical, such as acute myocarditis, particularly when accompanied by a hypertensive crisis. Early diagnosis enables optimal management and improves the prognosis.