Cardiogenic shock due to pheochromocytoma-induced catecholamine crisis in a young woman

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Pheochromocytoma-induced cardiogenic shock (n=1). Intervention: Adrenalectomy and alpha/beta-adrenergic blockade. Primary outcome: Recovery of cardiac function.

Q: What does this research mean for the field?

Pheochromocytoma-induced catecholamine crisis presenting as cardiogenic shock is reversible following medical stabilization and adrenalectomy. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Thirza van der Linden; Bjorn Dumont; Yalin Acardag; Johannes Hofland; Sjoerd Thijsse; Charlotte van Noord

doi:10.1210/jcemcr/luag199

July 2, 2026JCEM Case ReportsOpen Access

Cardiogenic shock due to pheochromocytoma-induced catecholamine crisis in a young woman

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Key result

Sequential blockade followed by adrenalectomy resolves pheochromocytoma-induced cardiomyopathy and normalizes metanephrines.

n=1

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Key Points

To describe an uncommon presentation of pheochromocytoma manifesting as cardiogenic shock and cardiac arrest, and to highlight diagnostic pitfalls and treatment outcomes.
Clinical, biochemical, and radiological evaluation of a previously healthy 30-year-old woman presenting in shock with severe metabolic acidosis (pH 6.97) and marked hyperglycemia (33.9 mmol/L).
Management included intensive resuscitation, vasopressor and inotropic therapy, targeted temperature management, continuous venovenous hemodialysis, sequential α- and β-adrenergic blockade, and surgical adrenalectomy.
Abdominal CT revealed a 7.5-cm heterogeneous right adrenal mass, accompanied by plasma normetanephrine levels elevated 127-fold and metanephrine levels elevated >242-fold.
Initial echocardiography demonstrated an almost akinetic left ventricle, with LVEF improving to ~25% post-resuscitation under milrinone and normalizing to 50% at 2 weeks.
Complete recovery of cardiac function with no abnormalities was confirmed on echocardiogram at 3 months following successful adrenalectomy.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 30-year-old previously healthy woman presenting with cardiogenic shock due to a pheochromocytoma-induced catecholamine crisis.

I

Intervention

Supportive care (vasopressors, intubation, CPR, milrinone, CVVH), alpha- and beta-adrenergic blockade (urapidil, oral blockers), and laparoscopic adrenalectomy.

O

Outcome

Recovery of cardiac function and normalization of plasma metanephrines after tumor resection.

Limitations

Measurement of plasma free (nor)metanephrines may be of limited value in the acute setting due to stress and administered vasopressors.

Implication

Pheochromocytoma-induced catecholamine crisis can present as cardiogenic shock mimicking diabetic ketoacidosis or sepsis, but cardiac function is highly reversible following appropriate medical blockade and surgical resection.

Abstract

A pheochromocytoma is a rare catecholamine-secreting tumor that can cause life-threatening complications. Circulatory shock with a significant cardiogenic component is an uncommon initial presentation. This case describes a previously healthy 30-year-old woman presenting with vomiting, hyperglycemia, and shock. This rapidly progressed to requiring intubation, vasopressor therapy, and resuscitation following cardiac arrest. Imaging revealed a right adrenal mass and plasma metanephrines and normetanephrines were markedly elevated. After stabilization with α- and β-adrenergic blockade, the patient underwent successful adrenalectomy, confirming a pheochromocytoma-induced catecholamine crisis, with full recovery of cardiac function. This case illustrates the diversity of initial presentation of pheochromocytoma, the diagnostic challenges associated with measuring plasma (nor)metanephrines after resuscitation and the reversible nature of catecholamine-induced cardiomyopathy.

Discussion

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Cite This Study

Linden et al. (2026) conducted a case report in Pheochromocytoma-induced cardiogenic shock (n=1). Adrenalectomy and alpha/beta-adrenergic blockade was evaluated on Recovery of cardiac function.

synapsesocial.com/papers/6a6794fcbb2605d1235fba4e https://doi.org/10.1210/jcemcr/luag199

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Cardiogenic shock due to pheochromocytoma-induced catecholamine crisis in a young woman

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Cardiogenic shock due to pheochromocytoma-induced catecholamine crisis in a young woman

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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