Acute coronary syndrome: Uncommon presentation of multiple endocrine neoplasia

Myocardial infarction is usually due to thrombotic occlusion of a coronary vessel caused by rupture of a vulnerable atherosclerosis plaque. There is also the acute myocardial infarction with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction with non-obstructive coronary arteries (MINOCA) such as Takotsubo, myocarditis and catecholamine induced cardiomyopathy. Pheochromocytoma is one of the causes of MINOCA. This association is rare but it may delay diagnosis and must be known in order to provide the best chance at early detection. This work has been reported in the line with the SCARE criteria.

We report a case of a 49 year-old man, admitted to our department for a recurrence of myocardial infarction with angiographically normal coronary arteries. During his hospitalization the patient complained of intestinal haemorrhage. The abdominal Computed tomographic scan revealed bilateral adrenal mass. The diagnosis of pheochromocytoma was made and confirmed by a high level of normetanephirnes and metanephrines.

The coexistence of multiple endocrine neoplasia type 2 and myocardial infarction appears to be a rare association rather than a coincidence.

In this case we highlight the importance of thorough history taking and investigation for the determining the aetiology of MINOCA. As a reversible cause of myocardial dysfunction, catecholamine-induced cardiomyopathy can occur as a feature of multiple endocrine neoplasia. The prognosis depends greatly on early diagnosis and prompt medical and surgical treatment, which are unfortunately often delayed because of the challenging diagnosis in many cases.