Case Report: Methylprednisolone-induced pheochromocytoma crisis resulting in cardiac arrest

Pheochromocytoma crisis, a rare yet life-threatening endocrine emergency, is characterized by acute hemodynamic instability that can lead to severe cardiovascular collapse, including cardiac arrest. Systemic glucocorticoid administration has been shown to trigger such crises in patients with pheochromocytoma. This report describes a 38-year-old female who developed symptoms including chest tightness, dyspnea, and vomiting shortly after receiving a methylprednisolone injection for urticaria, suggesting a possible association between glucocorticoid administration and the subsequent crisis. On admission, she suffered cardiac arrest and was managed with extracorporeal membrane oxygenation (ECMO). Coronary angiography, blood microbial RNA analysis, and metagenomic testing revealed no abnormalities. Despite comprehensive pharmacological treatment, the patient's symptoms persisted, with recurrent ventricular fibrillation detected on electrocardiogram, prompting further investigations. A computed tomography (CT) scan identified an adrenal mass, and biochemical tests confirmed the diagnosis of pheochromocytoma. Following successful laparoscopic adrenalectomy, the patient experienced significant clinical improvement. This case demonstrates the potential for methylprednisolone to trigger or contribute to a pheochromocytoma crisis. However, it is important to acknowledge that other concurrent factors, such as use of medication, systemic inflammatory response, and physiological stress of resuscitative interventions, may have also played a role. The challenges posed by the diagnosis of this condition underscore the need for caution when administering glucocorticoids to patients with suspected pheochromocytoma.