Transient cardiogenic shock during a crisis of pheochromocytoma triggered by high-dose exogenous corticosteroids.

ABSTRACT: We report a case of a 39-year-old woman who presented to the emergency department (ED) with symptoms of pharyngitis and fever. Diagnosed with streptococcal pharyngitis, she received antibiotics and dexamethasone, and was discharged. Within 24?h she returned to the ED with signs and symptoms of an acute coronary syndrome; she was thus given ?-blockers. Her coronary angiogram was normal. She developed cardiogenic shock with an ejection fraction (EF) of 10% and apical ballooning on echocardiography. Her condition improved with optimal medical therapy. Subsequent testing weeks later confirmed the presence of a pheochromocytoma. Following prazosin and an adrenalectomy, all her antihypertensive medications were weaned and her EF normalised. We believe the high-dose exogenous corticosteroids triggered a pheochromocytoma crisis. The concomitant use of ?-blockers without preceding ? blockade resulted in cardiovascular collapse. Pheochromocytoma crisis must be included in the differential diagnosis of any dramatic haemodynamic collapse after administration of exogenous corticosteroid or ?-blockers.

SUBMITTER: Ibrahim M 

PROVIDER: S-EPMC4336878 | biostudies-other | 2015 Feb

REPOSITORIES: biostudies-other