Abstract
We report a case of pheochromocytoma presenting as catecholamine cardiomyopathy and noncardiogenic pulmonary edema successfully treated with afterload reduction. A 34-year-old male was admitted to our hospital with complaints of dyspnea and cold sweating. The blood pressure was 130/100 mmHg and the heart rate was 150 min-1. The chest X-ray showed pulmonary edema and the echocardiography revealed diffuse left ventricular dysfunction (ejection fraction of 20%) without left atrial or ventricular over distension. He was treated with a continuous infusion of nicardipine and oral bunazocin. He was diagnosed as pheochromocytoma with a marked increase in serum concentrations of catecholamines (adrenaline 52,009 pg·ml-1, noradrenaline 35,810 pg·ml-1) and the left adrenal tumor on the abdominal CT scan. Pulmonary edema disappeared on the next day and he was free from dyspnea. The left ventricular contraction was improved, and the ejection fraction increased to 24% on the 2nd day and 58% on the 3rd day. The serum adrenaline and noradrenaline concentrations decreased to 6,140 and 6,669 pg·ml-1, respectively on the 3rd day. A pheochromocytoma was removed successfully on the 12th day. The serum catecholamine concentrations became normal on the 18th day and he was discharged on the 28th day.
