Thyrotoxic and pheochromocytoma multisystem crisis: a case report

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Emergency Medicine

Background:

• Thyrotoxic crisis and pheochromocytoma multisystem crisis are rare, life-threatening endocrine emergencies.
• Simultaneous presentation of both crises is exceptionally uncommon and presents significant management challenges.

Observation:

• A 60-year-old man presented with symptoms of both thyrotoxic crisis and pheochromocytoma multisystem crisis.
• Initial management included antithyroid drugs, steroids, and cardiovascular medications.
• Despite escalating treatment, the patient exhibited persistent hemodynamic instability, necessitating further diagnostic evaluation.

Findings:

• Elevated thyroid hormones and suppressed TSH confirmed thyrotoxicosis.
• Elevated serum catecholamines and an adrenal mass indicated pheochromocytoma.
• The patient required intensive cardiovascular support, including escalating alpha and beta-adrenergic blockade, to manage simultaneous crises.

Implications:

• Simultaneous thyrotoxic and pheochromocytoma crises demand complex and individualized cardiovascular management strategies.
• Beta-blockade augmentation under intensive care was necessary for thyrotoxic crisis management, diverging from typical pheochromocytoma protocols.
• This case highlights the critical need for vigilant monitoring and tailored interventions in managing rare, co-occurring endocrine emergencies.