SUN-507 - Refractory Cardiogenic Shock with Multi Organ Failure Revealing Pheochromocytoma

Background:

Pheochromocytoma is a rare catecholamine‑secreting tumor arising from chromaffin cells of the adrenal medulla. Although classically associated with paroxysmal hypertension, headache, and diaphoresis, its clinical spectrum is highly variable. Excess catecholamine release can precipitate severe cardiovascular manifestations, including stress‑induced or toxic catecholamine cardiomyopathy, leading to cardiogenic shock and multiorgan failure.

Clinical

Case:

A 45-year-old male with no prior medical history presented with acute shortness of breath requiring intubation and was found to be in cardiogenic shock. Hemodynamic assessment via left and right heart catheterization demonstrated a cardiac index of 1.5 L/min/m² without obstructive coronary artery disease and left ventricular ejection fraction (LVEF) of 10%. The patient required inotropic support with dobutamine and mechanical circulatory support with intra-aortic balloon pump.

The course was complicated by multiorgan failure including ischemic hepatitis (AST/ALT 14,328/8,542 U/L) and acute kidney injury requiring hemodialysis. Given the unexplained shock, computed tomography of the abdomen obtained as part of broad evaluation revealed a 5.8 × 5.5 cm adrenal mass (49 Hounsfield units). Plasma metanephrine (2.82) and normetanephrine (4.28) were elevated, consistent with Pheochromocytoma.

After stabilization and discontinuation of vasopressors, the patient was transiently managed with intravenous nicardipine for blood pressure control, followed by initiation of alpha-adrenergic blockade with doxazosin, guideline-directed medical therapy including carvedilol and hydralazine. This resulted in progressive hemodynamic improvement and recovery of end-organ function with partial recovery of LVEF to 30% within two weeks. After four months, the patient underwent laparoscopic adrenalectomy with findings consistent with pheochromocytoma.

Discussion:
Pheochromocytoma represents a rare but potentially reversible cause of cardiogenic shock. Excess catecholamine secretion induces profound vasoconstriction, tachyarrhythmia, and direct myocardial toxicity through oxidative stress and calcium overload. These mechanisms lead to transient left ventricular dysfunction resembling Takotsubo cardiomyopathy or fulminant myocarditis.

Conclusion:
Pheochromocytoma should be considered in unexplained cardiogenic shock with multiorgan failure. Awareness of this atypical presentation enables timely diagnosis, appropriate hemodynamic management, and curative surgical intervention, transforming an otherwise fatal course into a recoverable condition.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*