More Than Myocarditis? Cardiac Involvement in Phaeochromocytoma-A Case Report.
Source: PubMed, NCBI / U.S. National Library of Medicine
Phaeochromocytoma is a rare catecholamine-secreting neuroendocrine tumour arising from chromaffin cells of the adrenal medulla or from extra-adrenal paraganglionic tissue, in which case it is termed paraganglioma. Its clinical presentations are highly variable with up to 10-20% of patients being asymptomatic or having non-specific symptoms, therefore leading to frequent misdiagnosis. The aim of this case report is to present a rare and diagnostically challenging presentation as well as highlight the need to maintain a high index of suspicion in patients with unexplained cardiovascular symptoms. A 54-year-old female presented with acute chest pain and atrial fibrillation, initially suggestive of acute coronary syndrome. However, coronary angiography demonstrated unobstructed coronary arteries, and electrocardiogram (ECG) changes resolved. Persistent symptoms and refractory hypertension prompted further investigation, which revealed a left adrenal mass and significantly elevated urinary metanephrines, consistent with a diagnosis of phaeochromocytoma. After the diagnosis was confirmed by Endocrinology, treatment with phenoxybenzamine was initiated and titrated to 10 mg twice daily, resulting in stabilisation of her blood pressure and heart rate. Bisoprolol was added for further rate control. Following preoperative optimisation, the patient later underwent an uncomplicated laparoscopic adrenalectomy. At follow-up, she remained in sinus rhythm with a normalised blood pressure and
Abstract
Phaeochromocytoma is a rare catecholamine-secreting neuroendocrine tumour arising from chromaffin cells of the adrenal medulla or from extra-adrenal paraganglionic tissue, in which case it is termed paraganglioma. Its clinical presentations are highly variable with up to 10-20% of patients being asymptomatic or having non-specific symptoms, therefore leading to frequent misdiagnosis. The aim of this case report is to present a rare and diagnostically challenging presentation as well as highlight the need to maintain a high index of suspicion in patients with unexplained cardiovascular symptoms. A 54-year-old female presented with acute chest pain and atrial fibrillation, initially suggestive of acute coronary syndrome. However, coronary angiography demonstrated unobstructed coronary arteries, and electrocardiogram (ECG) changes resolved. Persistent symptoms and refractory hypertension prompted further investigation, which revealed a left adrenal mass and significantly elevated urinary metanephrines, consistent with a diagnosis of phaeochromocytoma. After the diagnosis was confirmed by Endocrinology, treatment with phenoxybenzamine was initiated and titrated to 10 mg twice daily, resulting in stabilisation of her blood pressure and heart rate. Bisoprolol was added for further rate control. Following preoperative optimisation, the patient later underwent an uncomplicated laparoscopic adrenalectomy. At follow-up, she remained in sinus rhythm with a normalised blood pressure and resolution of symptoms. This case highlights the diagnostic challenge posed by phaeochromocytoma, which can mimic myocardial infarction and myocarditis due to catecholamine-induced cardiac effects.