Pheochromocytoma-induced cardiogenic shock requiring ECMO: cardiovascular recovery prior to surgical resection

An otherwise healthy woman in her 30s presented with cardiogenic shock and acute pulmonary oedema (APO), subsequently requiring extracorporeal membrane oxygenation (ECMO). A CT scan revealed an adrenal mass that prompted the differential diagnosis of a pheochromocytoma crisis that was later further suggested by raised plasma metanephrines. In the absence of clear guidelines due to the clinical rarity, a decision was made to delay adrenalectomy and stabilise the patient from a cardiac perspective with the view to operate after improvement of cardiac function with adequate alpha and beta blockade. Despite multiple complications, the patient was discharged from the hospital on day 32. After stabilisation and improvement of cardiac function, the patient underwent laparoscopic adrenalectomy. She was haemodynamically stable throughout the operation and was discharged on postoperative day 1 from the ICU to home. Histology confirmed the diagnosis of pheochromocytoma. She has been stable on follow-up.