Propranolol-induced pulmonary edema and shock in a patient with pheochromocytoma

Sudden onset of pulmonary edema after administration of intravenous propranolol hydrochloride developed in a patient with pheochromocytoma but without clinical or histological evidence of heart disease. Previous cases of pulmonary edema have been reported in association with oral propranolol therapy but have failed to document histological absence of cardiac pathology. The mechanism for the development of pulmonary edema may have been a propranolol-induced beta 1- and beta 2-blockade that led to unopposed alpha effects and sudden elevation of afterload. This case underlines the caution that should be used in the administration of propranolol when the diagnosis of pheochromocytoma is considered.