Endocrine Abstracts

Introduction: Pheochromocytoma, a rare catecholamine-secreting tumor, typically presents with paroxystic hypertension, tachycardia, headache, and diaphoresis. Less frequently, symptoms imply substantial hemodynamic compromise and cardiogenic shock may occur. The delay time in diagnosis is approximately 3 years.

Case Presentation: This is a 41-year-old woman with no relevant history or cardiovascular risk factors, who presented with stress-induced cardiomyopathy or TakoTsubo syndrome, associated with intense headache. The hemodynamic study revealed normal coronary arteries and a reduced left ventricular ejection fraction (LVEF) of 40%, with altered segmental contraction on cardiac magnetic resonance. A year later, she required a new admission due to angina refractory to diltiazem and nitrates; a diagnosis of Prinzmetal’s angina was made. A CT scan was performed to rule out non-coronary etiology, and an 8 cm adrenal mass compatible with pheochromocytoma was incidentally found. The study was completed with metanephrines in urine and PET-CT, confirming the diagnosis. Prior to the intervention, alpha blockade with doxazosin was started, with notable difficulties in management, requiring a multidisciplinary approach with cardiology and intensive medicine for dosing, due to the patient’s symptomatic hypotension when the dose was increased, and rest angina associated with alterations in repolarization with its decrease. After beta blockade with metoprolol, right adrenalectomy was performed, without incident. The patient’s evolution was favorable, with recovery of the LVEF and disappearance of arterial hypertension and headache, although maintaining some occasional episodes of vasospastic angina. Postoperative urinary metanephrines were normal. The genetic study was negative for MEN-1, VHL, NF-1, RET, SDHAF2 SDHB, SDHC, SDHD, TSC1, TSC2.

Discussion and Conclusions: Endocrine causes should be taken into account and ruled out in the differential diagnosis of angina, given that catecolamine-induced cardiomyopathy is potentially reversible.