Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2021; 9(15): 3752-3757
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3752
Pheochromocytoma in a 49-year-old woman presenting with acute myocardial infarction: A case report
Hao-Yu Wu, Yi-Wei Cao, Tian-Jiao Gao, Jian-Li Fu, Lei Liang
Hao-Yu Wu, Lei Liang, Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi'an 710068, Shaanxi Province, China
Yi-Wei Cao, Department of Electrocardiology, Shaanxi Provincial People’s Hospital, Xi'an 710068, Shaanxi Province, China
Tian-Jiao Gao, Department of Gastroenterology, Xi’an Children’s Hospital, Xi'an 710068, Shaanxi Province, China
Jian-Li Fu, Ultrasonic Diagnosis Center, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
Author contributions: Wu HY and Cao YW drafted the manuscript; Wu HY, Fu JL, and Liang L participated in the treatment of this patient; Wu HY, Cao YW, and Gao TJ revised the manuscript; all authors have read and approved the final version of the manuscript.
Supported by the Natural Science Basic Research Program of Shaanxi Province, No. 2020JQ-939; and the Science and Technology Development Incubation Fund Project of Shaanxi Provincial People’s Hospital, No. 2019YXQ-08.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Wei Cao, MD, PhD, Doctor, Department of Electrocardiology, Shaanxi Provincial People’s Hospital, No. 256 West Youyi Road, Xi'an 710068, Shaanxi Province, China. 807422365@qq.com
Received: January 10, 2021
Peer-review started: January 10, 2021
First decision: February 12, 2021
Revised: February 15, 2021
Accepted: March 8, 2021
Article in press: March 8, 2021
Published online: May 26, 2021
Abstract
BACKGROUND

Pheochromocytoma is a rare endocrine tumor arising from chromaffin cells and having extensive and profound effects on the cardiovascular system by continuously or intermittently releasing catecholamines. The clinical manifestations of pheochromocytoma are diverse, and the typical triad, including episodic headache, palpitations, and sweating, only occurs in 24% of pheochromocytoma patients, which often misleads clinicians into making an incorrect diagnosis. We herein report the case of a patient with intermittent chest pain and elevated myocardial enzymes for 2 years who was diagnosed with pheochromocytoma.

CASE SUMMARY

A 49-year-old woman presented with intermittent chest pain for 2 years. Two years ago, the patient experienced chest pain and was diagnosed with acute myocardial infarction, with 25% stenosis in the left circumflex. The patient still had intermittent chest pain after discharge. Two hours before admission to our hospital, the patient experienced chest pain with nausea and vomiting, lasting for 20 min. Troponin I and urinary norepinephrine and catecholamine levels were elevated. An electrocardiogram indicated QT prolongation and ST-segment depression in leads II, III, aVF, and V3-V6. A coronary computed tomography angiogram revealed no evidence of coronary artery disease. Echocardiography showed left ventricular enlargement and a decreased posterior inferior wall motion amplitude. Contrast-enhanced computed tomography demonstrated an inhomogeneous right adrenal mass. The patient successfully underwent laparoscopic right adrenalectomy, and histopathology confirmed adrenal pheochromocytoma. During the first-year follow-up visits, the patient was asymptomatic. The abnormal changes on echocardiography and electrocardiogram disappeared.

CONCLUSION

Clinicians should be aware of pheochromocytoma. A timely and accurate diagnosis of pheochromocytoma is essential for alleviating serious cardiac complications.

Keywords: Pheochromocytoma, Catecholamine, Cardiac complications, Acute myocardial infarction, Chest pain, Case report

Core Tip: Pheochromocytoma releases excessive amounts of catecholamines, which can have mild to catastrophic effects on the cardiovascular system, such as hypertension, myocardial infarction, cardiomyopathy, arrhythmias, and heart failure. However, most of the cardiovascular complications are reversible after pheochromocytoma resection. Clinicians should be aware of pheochromocytoma. A timely and accurate diagnosis of pheochromocytoma is essential for alleviating serious cardiac complications.