Abstract
We report a case of pheochromocytoma that presented with progressive heart failure. The patient was successfully treated with early surgical intervention with percutaneous cardiopulmonary support (PCPS). This patient, a 32-year-old man, was admitted to our ICU for recurrence of hypertensive crisis. Abdominal CT revealed a left adrenal tumor diagnosed as a pheochromocytoma. Although treatment with vasodilators and volume loading was initiated, the patient's condition rapidly progressed to severe congestive heart failure. We thought that eliminating the catecholamine release from the tumor could greatly increase the chances of the patient's survival, and therefore, we performed emergency surgery for tumor removal with PCPS, which facilitated better oxygenation and provided circulatory support. Unexpectedly, the patient was hemodynamically stable during surgery. Examination of the resected tumor revealed massive hemorrhagic necrosis, which suggested that the catecholamine release from the tumor had stopped before surgery. The patient was promptly weaned from PCPS after surgery. Subsequently, his cardiac function recovered favorably, and he was discharged from our hospital 21 days after admission. In the case of patients with pheochromocytoma developing progressive heart failure, physicians should consider the possibility of sudden cessation of catecholamine release following acute tumor necrosis as well as of catecholamine-induced cardiomyopathy.
