Anesthetic management of pheochromocytoma complicated by Takotsubo syndrome: A case report about a dual challenge

INTRODUCTION AND IMPORTANCE: Anesthetic management of pheochromocytoma is challenging due to the risk of severe hemodynamic instability. Recent evidence suggests an association with Takotsubo syndrome, complicating perioperative care. Awareness of this complication is crucial for optimizing management and improving outcomes. CASE PRESENTATION: We report a 42-year-old female undergoing preoperative evaluation for an adrenal mass, diagnosed as pheochromocytoma. Echocardiography revealed dilated cardiomyopathy consistent with Takotsubo syndrome. Preoperative optimization included alpha- and beta-blockade. Anesthetic management focused on maintaining hemodynamic stability with invasive monitoring. The surgery was uneventful, and the patient recovered in the intensive care unit with gradual improvement in cardiac function. CLINICAL DISCUSSION: This case illustrates the link between pheochromocytoma and Takotsubo syndrome, likely triggered by catecholamine excess. It highlights the importance of careful preoperative preparation and vigilant intraoperative monitoring to minimize cardiovascular complications. CONCLUSION: Takotsubo syndrome should be considered in patients with pheochromocytoma due to its impact on anesthetic management. Comprehensive perioperative care is essential for successful outcomes.