[Cardiogenic shock in a 61 year old female with recurrent panic attacks]

Area of Science:

• Cardiology
• Endocrinology
• Oncology

Background:

• Acute coronary syndrome (ACS) is a critical condition often presenting with chest pain and elevated cardiac biomarkers.
• Differential diagnosis for ACS can be complex, especially in patients with comorbidities or atypical presentations.

Observation:

• A 61-year-old patient presented with epigastric pain, elevated troponin T and creatine kinase, and reduced left ventricular function, initially suggesting ACS.
• Coronary angiography excluded coronary artery disease, prompting further investigation.
• Abdominal ultrasound revealed an adrenal mass, leading to the diagnosis of pheochromocytoma.

Findings:

• Elevated urinary catecholamines and CT scan confirmed pheochromocytoma.
• The patient experienced cardiogenic shock and multiple organ failure due to massive catecholamine secretion.
• Resection of a benign pheochromocytoma was performed after medical stabilization.

Implications:

• Pheochromocytoma can mimic ACS, leading to misdiagnosis and delayed treatment.
• Early consideration of pheochromocytoma in patients with recurrent panic attacks and hypertension is crucial.
• This case underscores the potential for adrenal tumors to cause severe cardiovascular compromise.