Shehzad Mustafa, Shehzad Dawood, Ahmad Muhammad, Younis Humna, Wassey Abdul, Fatima Rida
Internal Medicine, Hackensack University Medical Center, Hackensack, USA.
Internal Medicine, University of South Dakota, Sioux Falls, USA.
Eur J Case Rep Intern Med. 2024 Sep 4;11(10):04825. doi: 10.12890/2024_04825. eCollection 2024.
Pheochromocytomas can present as a diagnostic challenge, given their diverse clinical manifestations. Though classically taught as presenting with headaches, palpitations and paroxysmal hypertension, only 1 in 4 present with such a triad. Catecholamines affect the myocardium in various ways, ranging from beta-adrenergic receptor-mediated myofibril dysfunction to direct myocardial injury by catecholamine oxidation products.
We report the case of a 41-year-old female with no significant past medical history, who presented with acute coronary syndrome. She was found to have myocardial infarction with non-obstructive coronary arteries (MINOCA), and her clinical course was complicated by erratic blood pressure management. Laboratory findings and imaging findings confirmed the diagnosis of pheochromocytoma. Post-cardiac catheterisation, she developed a thyroid storm and fatal cardiac arrest.
The combination of hyperthyroidism with pheochromocytoma is rare but often fatal; iodinated angiography contrast likely precipitated her thyroid storm. This case underscores the importance of considering pheochromocytoma early in patients with MINOCA, particularly in those with erratic blood pressure. Pheochromocytomas have been reported to be associated with MINOCA in rare cases and have significant mortality. Current guidelines do not include pheochromocytoma as a possible differential diagnosis; recognition and early diagnosis are crucial for improved outcomes.
Pheochromocytoma and thyroid disease should be added as recommended differential diagnoses in patients with myocardial infarction with non-obstructive coronary artery disease (MINOCA) despite current guidelines not including them in the routine work-up.For patients with erratic blood pressure and MINOCA, the possibility of a pheochromocytoma should be considered early, as a prompt diagnosis can result in favourable outcomes.
嗜铬细胞瘤因其临床表现多样，可能带来诊断挑战。尽管传统上认为其表现为头痛、心悸和阵发性高血压，但只有四分之一的患者会出现这三联征。儿茶酚胺以多种方式影响心肌，从β-肾上腺素能受体介导的肌原纤维功能障碍到儿茶酚胺氧化产物导致的直接心肌损伤。
我们报告一例41岁女性，既往无重大病史，因急性冠状动脉综合征就诊。她被诊断为非阻塞性冠状动脉心肌梗死（MINOCA），其临床过程因血压管理不稳定而复杂化。实验室检查和影像学检查结果确诊为嗜铬细胞瘤。心脏导管检查后，她发生了甲状腺危象并导致致命的心脏骤停。
甲状腺功能亢进与嗜铬细胞瘤同时存在的情况罕见但往往致命；碘化血管造影剂可能诱发了她的甲状腺危象。该病例强调了在MINOCA患者中早期考虑嗜铬细胞瘤的重要性，尤其是那些血压不稳定的患者。据报道，嗜铬细胞瘤在罕见情况下与MINOCA相关，且死亡率较高。目前的指南未将嗜铬细胞瘤列为可能的鉴别诊断；识别和早期诊断对于改善预后至关重要。
尽管目前的指南未将嗜铬细胞瘤和甲状腺疾病纳入心肌梗死伴非阻塞性冠状动脉疾病（MINOCA）患者的常规检查中，但应将其作为推荐的鉴别诊断添加进来。对于血压不稳定的MINOCA患者，应尽早考虑嗜铬细胞瘤的可能性，因为及时诊断可带来良好的预后。
