Key result
Pheochromocytoma resection completely reverses severe catecholamine-induced cardiomyopathy and cardiogenic shock.
Why the study?
Pheochromocytoma can mimic acute coronary syndrome with cardiogenic shock and elevated troponin despite absence of obstructive coronary artery disease, leading to frequent misdiagnosis.
Case Report (n=1)
No
Pheochromocytoma should be considered in the differential diagnosis of patients presenting with MINOCA and unexplained cardiogenic shock, as catecholamine-induced cardiomyopathy is fully reversible following tumor resection.
Case supports pheochromocytoma consideration in unexplained MINOCA shock; leaves open prospective validation of screening.
BACKGROUND Pheochromocytoma is a rare neuroendocrine tumor arising from chromaffin cells of the adrenal medulla that can manifest as catecholamine-induced cardiomyopathy mimicking acute coronary syndrome. Misdiagnosis is common, particularly when cardiogenic shock and elevated troponin levels occur in the absence of obstructive coronary artery disease. We describe pheochromocytoma masquerading as acute coronary syndrome complicated by cardiogenic shock, highlighting key diagnostic clues and management strategies. CASE REPORT A 59-year-old man with a 10-year history of intermittent chest tightness exhibited acute cardiogenic shock, peak troponin I level of 5.48 ng/mL, and N-terminal pro-B-type natriuretic peptide level of 19 800 pg/mL. Initial electrocardiography showed sinus tachycardia and T-wave abnormalities. Echocardiography revealed a reduced left ventricular ejection fraction of 40% with regional wall motion abnormalities. Coronary angiography demonstrated no significant stenosis, consistent with myocardial infarction with non-obstructive coronary arteries (MINOCA). Plasma free normetanephrine and metanephrine levels were 653.9 pg/mL (>680 times the upper limit of normal) and 378.5 pg/mL (>630 times the upper limit of normal), respectively. Abdominal computed tomography identified a right adrenal mass. After 2 weeks of preoperative alpha-blockade with phenoxybenzamine and volume expansion, the patient underwent laparoscopic adrenalectomy. Histopathology confirmed pheochromocytoma. Postoperatively, cardiac function normalized and symptoms completely resolved. CONCLUSIONS Pheochromocytoma should be suspected in patients with MINOCA and unexplained cardiogenic shock, particularly when accompanied by labile blood pressure. Substantially elevated plasma metanephrine and adrenal imaging facilitate early diagnosis. Catecholamine-induced cardiomyopathy is reversible after tumor resection. Multidisciplinary management, from hemodynamic stabilization to definitive surgery, is essential.
No takes yet. Share an insight, caveat, or question.
Zhang et al. (2026) conducted a case report in Pheochromocytoma masquerading as acute coronary syndrome with cardiogenic shock (n=1). Laparoscopic adrenalectomy and alpha-blockade (phenoxybenzamine) was evaluated. Surgical resection of an adrenal pheochromocytoma completely reversed severe catecholamine-induced cardiomyopathy and cardiogenic shock in a patient misdiagnosed with acute coronary syndrome.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: