Unrecognized pheochromocytoma manifesting as Takotsubo cardiomyopathy

Pheochromocytoma is a rare endocrine tumour originating from the adrenal medulla, most commonly presenting with episodic hypertension, headache, diaphoresis, and tachycardia resulting from excessive catecholamine production. This report describes a 54-year-old woman who repeatedly presented with symptoms suggestive of pheochromocytoma but did not undergo specific diagnostic evaluation. Subsequently, she developed transient chest pain, elevated troponin T levels, and an electrocardiogram demonstrating a Wellens pattern. Acute coronary angiography revealed no abnormalities, while transthoracic echocardiography indicated Takotsubo cardiomyopathy, evidenced by a reduced left ventricular ejection fraction of 40% and apical akinesia. Several months later, the patient was diagnosed with pheochromocytoma. This case highlights the diagnostic challenges posed by a rare disease as pheochromocytoma, with initially nonspecific symptoms and various clinical presentations, including Takotsubo cardiomyopathy.