Pheochromocytoma complicated with acute myocardial infarction and cerebral infarction: a case report

Pheochromocytoma is a relatively rare neuroendocrine tumor originating from chromaffin cells of the adrenal medulla. Characterized by excessive catecholamine release, it typically presents with paroxysmal or sustained hypertension, palpitations, and other related symptoms. Catecholamine-mediated sustained hypertension can cause vascular endothelial injury, atherosclerotic plaque formation, and vasospasm, thereby increasing the risk of cardiovascular and cerebrovascular events. Cases of acute myocardial infarction and cerebral infarction at the same time are extremely rare. Owing to the lack of typical tumor-related symptoms, patients are easily misdiagnosed with primary hypertension complicated by cardiovascular and cerebrovascular diseases, leading to inappropriate clinical management.

This case reports a 70-year-old female patient with acute ST-segment elevation myocardial infarction, who was initially treated with antiplatelet and anticoagulant therapy. The day after admission, she suffered from acute massive cerebral infarction and underwent emergency intracranial thrombectomy. During the operation, it was confirmed that the right internal carotid artery and superior trunk of the right middle cerebral artery were occluded, and a large amount of thrombus was removed. Further history taking revealed a prior diagnosis of right adrenal pheochromocytoma. Subsequent laboratory examination showed significant elevation of urinary vanillylmandelic acid. Coronary computed tomography angiography showed only mild stenosis, and the patient was considered to have myocardial infarction with non-obstructive coronary arteries and type 2 myocardial infarction. A subdural hematoma occurred after operation, and the patient's condition gradually stabilized after dynamic adjustment of the antithrombotic regimen. The patient's family refused surgical resection of the tumor. She had been taking phenoxybenzamine orally for a long time to control blood pressure after discharge. The patient's prognosis was good during follow-up.

Acute myocardial infarction and cerebral infarction were not independent events but rather sequential manifestations of systemic vasculopathy mediated by catecholamine storm. For patients with severe blood pressure fluctuations and unexplained multi-organ ischemia, screening for pheochromocytoma should be performed as soon as possible. Early identification, standardized use of α-blockers, and individualized adjustment of antithrombotic strategy are critical to improve the prognosis in such critically ill patients.