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Updated: May 14, 2025
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
[Spontaneous coronary artery dissection associated with pheochromocytoma : A rare case report]
Minh Tam Bailly1, Marie Arnal1, O Labidi1
1Department of Cardiology, Kremlin Bicêtre Hospital, Paris, France.
Insights
Spontaneous coronary artery dissection (SCAD) is a rare condition. This case highlights a unique instance where pheochromocytoma, a rare adrenal tumor, contributed to SCAD, emphasizing the need for early detection and multidisciplinary care.
Area of Science:
- Cardiology
- Endocrinology
- Oncology
Context:
- Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndromes, particularly in younger women.
- Pheochromocytoma, a rare neuroendocrine tumor, can cause significant cardiovascular complications due to catecholamine excess.
- This report details a unique case linking SCAD to an undiagnosed pheochromocytoma.
Purpose:
- To report a rare case of spontaneous coronary artery dissection (SCAD) associated with pheochromocytoma.
- To underscore the importance of considering pheochromocytoma in patients presenting with SCAD.
- To emphasize the necessity of a multidisciplinary approach for managing such complex cases.
Summary:
- A 49-year-old female presented with ST-segment elevation myocardial infarction secondary to SCAD.
- Incidental discovery of a left adrenal pheochromocytoma during hospitalization.
- Successful surgical removal of the pheochromocytoma led to optimal recovery post-SCAD.
Impact:
- This case expands the known etiologies of SCAD, highlighting a potential endocrine link.
- Early detection and management of pheochromocytoma can be crucial in preventing recurrent SCAD events.
- Highlights the importance of advanced cardiac imaging and a collaborative medical approach in rare cardiovascular conditions.
Background:
Spontaneous coronary artery dissection (SCAD) is a rare and under-diagnosed disease that accounts for 1 to 4% of acute coronary syndromes and nearly one-third of heart attacks in women under the age of 50. We present a unique case of a pheochromocytoma that contributed to SCAD.
Case Summary:
A 49-year-old patient presented to the emergency department with chest pain that had been evolving for several days. The diagnosis was a late ST ST-segment elevation Myocardial Infarction (STEMI) in the anterior leads. Echocardiography has shown a severe left ventricular dysfunction related to a large akinesis of anterior and lateral segments. Coronary angiography revealed a recent occlusion due to spontaneous dissection of the mid left anterior descending artery and of the first and second obtuse marginal arteries. During the same hospitalization, incidental findings from a CT pulmonary angiography led to the discovery of a left adrenal mass. Subsequent abdominal scanning and blood/urine assays confirmed a diagnosis of pheochromocytoma. The patient underwent follow-up coronary angiography and cardiac MRI to evaluate cardiac involvement before undergoing surgical removal of the pheochromocytoma. The patient has undergone successful surgical ablation two months after STEMI in a referral center for endocrinology surgery with an optimal cardiological technical platform.
Discussion:
Spontaneous coronary artery dissection is a rare and potentially fatal disease and has never been described in the literature in association with a pheochromocytoma. Similar cases require a multidisciplinary approach, as well as surgery carried out in a facility equipped with advanced cardiac techniques. Given the curative potential of pheochromocytoma, early detection of SCAD is essential to reduce the risk of recurrence.
