A case report of a rare cause of reversible left ventricular dysfunction: pheochromocytoma

Pheochromocytoma and paraganglioma are infrequent neuro-endocrine neoplasms of the adrenal medulla chromafin cells which overproduce catecholamines. These neoplasms release prompt and extreme amount of catecholamines. Early diagnosis is critical to avoid life-threatening complications. But first, it is necessary to suspect pheochromocytoma. It is classically presenting with paroxysmal hypertension and intermittent episodes of headaches, diaphoresis, palpitations. Since acute or chronic catecholamine intoxication may lead to structural myocardial changes, a number life-threatening cardiovascular complications may occur during the course of this disease. Limited data exists on the presentation, managment and outcomes of such pheochromocytoma-induced cardiovascular complications. Besides, the cardiovascular manifestations of pheochromocytoma are usually associated with paroxysmal hypertensive crisis. Pheochromocytoma-induced left ventricle systolic dysfunction is a rare clinical entity and should be considered in the differential diagnosis of patients with idiopathic heart failure and without coronary stenosis, especially in those who have unexplained elevations in blood pressure. Surgical resection of the tumor is the mainstay of treatment. If done at appropriate time it has been shown to significantly improve the myocardial changes seen in the setting of pheochromocytoma. Our case highlights the importance of early suspicion and diagnosis for pheochromocytoma in such patients since a delay in diagnosis may contribute to irreversible myocardial remodeling.