[Pheochromocytoma with normal blood pressure and dilated cardiomyopathy: a case report]

A rare complication of normotensive pheochromocytoma with dilated cardiomyopathy is described. This 57-year-old man first experienced palpitation eight years ago when his blood pressure, electrocardiogram and chest radiograph were all within normal limits. Five years later he was admitted to another hospital because of palpitation and was diagnosed as having dilated cardiomyopathy on the basis of cardiac catheterization and cardiac muscle biopsy. In December, 1984, he was admitted to our hospital for treatment of congestive heart failure. On admission, his electrocardiogram revealed left atrial overloading, left axis deviation, left ventricular hypertrophy with intraventricular conduction disturbances and frequent premature ventricular contractions. Echocardiography revealed marked biventricular dilatation with severe hypokinesis of the interventricular septum and the posterior wall of the left ventricle, and a B-B' step of the anterior mitral leaflet. Fasting blood sugar was slightly elevated and a 75 g glucose tolerance test was abnormal. An abdominal echogram and abdominal CT revealed a 67 mm diameter mass immediately superior to the right kidney. Blood and urine catecholamine levels were significantly increased. He was diagnosed as having a pheochromocytoma. Interestingly, he had been normotensive during the eight years until his fatal outcome. He died of congestive heart failure. Needle necropsy findings of the adrenal revealed pheochromocytoma, and those of the cardiac muscle revealed enlarged muscle cells and mild fibrosis.