Pheochromocytoma crisis.

KEY CLINICAL MESSAGE: Adrenergic crisis induced by a pheochromocytoma leads to life-threatening catecholamine-induced hemodynamic disturbances. Successful treatment of a pheochromocytoma crisis demands prompt diagnosis, vigorous pharmacological therapy and emergent tumor removal, if the patient continues to deteriorate.

Question

What is the correct patient's diagnosis, and which is the most appropriate treatment?

A pheochromocytoma, treatment by tumor removal

A pheochromocytoma crisis, treatment by emergent tumor removal

A pheochromocytoma crisis, treatment by emergent tumor removal if vigorous pharmacological therapy fails

A pheochromocytoma, treatment by vigorous pharmacological therapy

Correct answer: C

A 49-year-old woman presented with a 1-day history of nausea. ECG showed anterior ST-segment elevations (V1–V6) (Figure A) and the troponin test was positive. Echocardiography disclosed anterior hypokinesia of the left ventricle with a left ventricular ejection fraction (LVEF) of 23%. The patient developed a cardiogenic shock accompanied by acute liver, kidney, and respiratory failures. Computed tomography showed an 8-cm right-sided adrenal mass with central necrosis (Figure B), which was removed in toto during emergency surgery (Figure C). Adrenergic crisis induced by a pheochromocytoma leads to life-threatening, catecholamine-induced hemodynamic disturbances. Successful treatment of a pheochromocytoma crisis demands prompt diagnosis, vigorous pharmacological therapy, and emergent tumor removal, if the patient continues to deteriorate.