Adrenergic myocarditis in pheochromocytoma

Area of Science:

• Cardiology
• Endocrinology
• Oncology

Background:

• Pheochromocytoma is a neuroendocrine tumor known for its diverse clinical presentations, often leading to diagnostic challenges.
• The condition is sometimes referred to as "the great masquerader" due to its ability to mimic various other diseases.
• Early and accurate diagnosis is crucial for effective management and preventing severe complications.

Observation:

• A middle-aged woman presented with non-specific symptoms suggestive of acute coronary syndrome or subacute myocarditis.
• Cardiovascular magnetic resonance (CMR) revealed myocardial edema and intramyocardial late gadolinium enhancement (LGE).
• An incidental adrenal mass was identified during cardiac imaging.

Findings:

• The adrenal mass was diagnosed as pheochromocytoma and surgically excised.
• The patient's presentation was consistent with acute adrenergic myocarditis.
• Post-surgical follow-up showed complete resolution of myocardial edema and LGE on CMR.

Implications:

• This case underscores the importance of considering pheochromocytoma in patients with unexplained cardiac symptoms, even when they mimic typical cardiac events.
• It demonstrates that pheochromocytoma can induce a reversible myocardial injury pattern, termed acute adrenergic myocarditis.
• Successful surgical removal of the pheochromocytoma led to the resolution of cardiac abnormalities, highlighting the curable nature of this condition.