[Pheochromocytoma and sudden death: a case of hyperacute myocardial ischemia]

Pheochromocytoma is the most frequent cause of adrenal sudden death, which is the unique sign in 1.5% of cases. After a short review of the literature, we report a case of a 36 years old asymptomatic woman, who died suddenly and unexpectedly while receiving preoperative treatment. Gross examination did not allow to reveal any cause of death. Microscopy revealed signs of acute myocardial ischemia, in the lack of any coronary and catecholaminic heart disease. Azan-Mallory trichromic stain was found to be necessary in revealing myocardial lesions. A plausible death pathway is the following: a single catecholaminic peak might have induced myocardic vessel spasm, which in turn could be responsible for a lethal arrhythmia; the dramatic pressure drop can be the effect of pump failure or of a paradoxical disproportionate beta stimulation.