Pheo very rarely causes
death in modern times. Whenever a patient dies of pheo, the diagnosis and
management of the patient’s pheo require detailed analysis. The lessons learned
from such an unfortunate death are invaluable.
I run into a case report published earlier this year. A
61-year-old male suddenly developed fatigue, nausea, vomiting, and shortness of
breath. He came to an emergency room 6 hours later. At the emergency room, he
initially had high blood pressure and heart rate. His condition deteriorated
quickly so that he was intubated. His markers of heart attack were elevated but
his coronary arteries were normal. His left heart ventricle exhibited abnormal
movement. He was diagnosed with takotsubo cardiomyopathy (a heart disease
caused by extreme stress). Chest X-ray showed signs of heart failure and CT showed
changes consistent with certain kind of pneumonia. 2 hours later, his blood
pressure suddenly dropped and he suffered from cardiac arrest. He died shortly
after. It was only 12 hours between the start of symptoms and death. Autopsy
found a 4-cm hemorrhagic pheochromocytoma in the right adrenal gland.
This case is typical for pheo-related sudden death. He was
apparently healthy before the onset of symptoms. He had no known pheo. His
symptoms suggested heart or lung diseases. He initially had high blood pressure
and heart rate. Testing and imaging showed he had normal coronary arteries but with
other heart and lung abnormalities. He then suddenly developed low blood
pressure and cardiac arrest and died quickly.
Was his death avoidable? It is hard to say. Were there
potential opportunities to make an early diagnosis of pheo and to institute
therapies? There probably were. In any patients with acute heart problems with
normal coronary arteries, pheo should be considered. Pheo is a rare cause of
heart problems but pheo-related heart problems are reversible. The probability of
pheo is much higher after the coronary arteries are shown to be normal. Takotsubo
cardiomyopathy cannot be reliably diagnosed without ruling out pheo. Therefore,
pheo should be considered in this patient. A particularly odd thing in this
case was that the chest CT did not mention the adrenal tumor. Chest CT should clearly
see a 4-cm adrenal mass. A large adrenal mass and acute heart and lung problems
without other plausible explanations only point to one disease, pheo-induced cardiomyopathy
and pulmonary edema. He should have been diagnosed earlier and been treated
with alpha blockade and aggressive cardiac support with all available devices. Believe
it or not, even the sickest patient with pheo-induced cardiomyopathy can
survive with early diagnosis and appropriate treatment.
Dr. Pheo
Dr. Pheo
