Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2021; 9(4): 951-959
Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.951
Pheochromocytoma as a cause of repeated acute myocardial infarctions, heart failure, and transient erythrocytosis: A case report and review of the literature
Fei Shi, Li-Xian Sun, Sen Long, Ying Zhang
Fei Shi, Li-Xian Sun, Ying Zhang, Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
Sen Long, Department of Traditional Chinese Medicine, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
Author contributions: Shi F managed the case and edited the manuscript; Zhang Y assisted with editing and revising the manuscript; Sun LX and Long S read and approved the final manuscript.
Supported by Science and Technology Support Plan Project of Chengde, China, No. 201701A072.
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 have no conflicts of interest to declare.
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: Ying Zhang, MD, Chief Doctor, Department of Cardiology, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Shuangqiao District, Chengde 067000, Hebei Province, China. cyfyzy@aliyun.com
Received: October 22, 2020
Peer-review started: October 22, 2020
First decision: November 20, 2020
Revised: November 25, 2020
Accepted: December 11, 2020
Article in press: December 11, 2020
Published online: February 6, 2021
Processing time: 94 Days and 23 Hours
Abstract
BACKGROUND

Pheochromocytoma is a rare catecholamines-secreting tumor arising from chromaffin cells in the adrenal medulla. It classically presents with paroxysmal hypertension, headaches, palpitations, sweating, and metabolic disorders. Atypical presentations such as acute myocardial infarction, heart failure, cardiomyopathy, stroke, and transient erythrocytosis have been infrequently documented.

CASE SUMMARY

We describe the case of a 72-year-old man diagnosed with pheochromocytoma presenting with non-ST segment elevation myocardial infarction, heart failure, and transient erythrocytosis with nonobstructed coronary arteries. This was his second heart attack. The patient was previously diagnosed with myocardial infarction, and an immense mass was found on the left adrenal gland 3 years prior. Based on clinical and laboratory findings, a diagnosis of pheochromocytoma was confirmed. His coronary angiogram showed nonobstructed coronary arteries except for a myocardial bridge in the left anterior descending branch. This was a form of type-2 myocardial infarction. The myocardial cell lesions were caused by sudden secretion of catecholamines by the pheochromocytoma. Even more atypically, his hemoglobin level was obviously elevated at admission, but after a few days of treatment with an alpha-adrenergic receptor blocker, it dropped to normal levels without additional treatment.

CONCLUSION

Pheochromocytoma may be a cause of acute myocardial infarction, heart failure, and transient erythrocytosis.

Keywords: Pheochromocytoma; Myocardial infarction; Heart failure; Cardiomyopathy; Erythrocytosis; Case report

Core Tip: Pheochromocytomas release massive amounts of catecholamines that can cause life-threatening cardiovascular complications, including cardiac arrhythmia, ST and non-ST segment elevation myocardial infarction, heart failure, and hypertensive urgency. For acute myocardial infarction with unexplained erratic blood pressure, headaches, palpitations, and sweating, pheochromocytoma should be considered a differential diagnosis. Pheochromocytoma is a non-atherosclerotic cause of myocardial infarction. The myocardial cell lesions may be caused by tachycardia, coronary artery spasm, or cardiomyopathy, which are related to excess catecholamines. Pheochromocy-toma with erythrocytosis is rarely reported. Elevated hematocrit contributes to increased blood viscosity and thus, to higher risk of coronary heart disease.