Key result
Pheochromocytoma resection resolves secondary hypertension and hemodynamic instability after initial MI presentation.
Why the study?
Initial manifestation of pheochromocytoma as acute NSTEMI is rare, and dramatic peri-procedural hemodynamic fluctuations make diagnosis and management challenging.
Case Report (n=1)
Pheochromocytoma can rarely present as Type 2 myocardial infarction with extreme peri-procedural hemodynamic instability, which resolves completely following surgical resection.
Extreme hemodynamic instability in MI may prompt pheochromocytoma evaluation; single case leaves open broader screening algorithms.
Pheochromocytoma typically presents with sustained or paroxysmal hypertension, but initial manifestation as acute non-ST-segment elevation myocardial infarction (NSTEMI) is rare. Peri-procedural hemodynamic fluctuations are often dramatic, making diagnosis and management challenging. We report a 51-year-old male admitted with chest tightness for 17 days. Elevated troponin and coronary angiography showing multivessel disease with total occlusion of the mid-left anterior descending artery (LAD) led to a preliminary diagnosis of NSTEMI. During percutaneous coronary intervention, blood pressure surged to 240/130 mmHg; intravenous nitroprusside caused an instantaneous drop to 95/55 mmHg, with rapid rebound to >200 mmHg upon withdrawal, showing no clear temporal relationship with drug administration. Postoperatively, large rapid blood pressure oscillations persisted, associated with postural changes but without patient discomfort. Workup revealed markedly elevated plasma catecholamines: dopamine 77.58 pg/mL (normal 0-20), normetanephrine 1881.63 pg/mL (0-145), and norepinephrine 5,724.04 pg/mL (217-1,109). CT and PET-CT identified a left retroperitoneal mass (59×34×44 mm, SUVmax 14.6), suggestive of pheochromocytoma. Surgical resection was performed, and histopathology with immunohistochemistry confirmed the diagnosis. Postoperatively, the patient required no antihypertensive medications and blood pressure remained stable. This case illustrates a rare pheochromocytoma presentation as secondary hypertension manifesting as acute myocardial infarction, characterized by extreme peri-procedural hemodynamic instability during PCI and an "all-or-none" response to conventional antihypertensive therapy, ultimately cured by surgical resection.
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Li et al. (2026) conducted a case report in Pheochromocytoma presenting as NSTEMI (n=1). Surgical resection of pheochromocytoma was evaluated on Blood pressure stability and need for antihypertensive medications post-surgery. Surgical resection of a pheochromocytoma cured secondary hypertension and stabilized extreme hemodynamic fluctuations in a patient who initially presented with acute myocardial infarction.
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