Pheochromocytoma Crisis: The Hidden Evil

Yang Hong*, Romanus Shao, Rui Dong and Fen Li

Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, China

^*Correspondance to: Yang Hong 

 PDF  Full Text DOI: 10.25107/2474-1647.3502

Abstract

Pheochromocytomas are catecholamine-secreting neuroendocrine tumors. They occur rarely but can cause life-threatening conditions like a multisystem crisis. A 37-year-old woman presented with lower abdominal pain and yellowish vaginal discharge a few hours after failed removal of the Intrauterine Contraceptive Device (IUCD). Per vaginal examination was normal but abdominal X-ray revealed air-fluid levels with free air under the diaphragm. We suspected intestinal obstruction, and an exploratory laparotomy was performed. The Blood Pressure (BP) and Heart Rate (HR) raised sharply before the procedure and were controlled. The post- laparotomy diagnosis was peritonitis secondary to IUCD perforation. Post laparotomy, the abdominal-pelvic ultrasound revealed a mass on the right adrenal gland, and we confirmed the diagnosis of pheochromocytoma after 24-h urinary metanephrine measurement. We planned for adrenalectomy once she was stable. However, she developed severe sepsis, and the second laparotomy was performed, which revealed extensive bowel necrosis. Afterwards, her condition improved and then started to deteriorate steadily. She became severe hemodynamically unstable with cardiogenic shock, pulmonary edema and sepsis. Despite intensive medical treatment, her condition deteriorated further, and she died on the 17thday post-admission secondary to refractory multi-organ failure induced by pheochromocytoma crisis. We present this case to illustrate a rare case of pheochromocytoma crisis triggered by bowel perforation. It presented with pulmonary edema, labile blood pressures and cardiogenic shock. This is also a wakeup call for doctors to perform thorough investigations and early interventions to reduce mortality. Medical education and medical history may help to improve the prognosis.

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Cite the article

Hong Y, Shao R, Dong R, Li F. Pheochromocytoma Crisis: The Hidden Evil. Clin Surg. 2022; 7: 3502..