An affair of the heart – phaeochromocytoma presenting as an acute coronary syndrome


T Imam, P Finny, R Khan, A Choo-Kang, Basildon University Hospital, Essex, UK

A 44 year old Caucasian man presented to the emergency department in acute cardiogenic shock with pulmonary oedema secondary to an acute myocardial infarction and a hyperosmolar hyperglycaemic state. The previous day he had undergone a colonoscopy which revealed features of colitis. He had been previously diagnosed with Type 2 Diabetes, Migraine and Anxiety attacks. Whilst awaiting an angiogram he developed upper abdominal pain and a CT scan was performed. This incidentally found a large right adrenal mass. Urinary free catecholamines were found to be elevated which raised the possibility of a phaeochromocytoma. Alpha blockade was commenced cautiously as he was post MI and he was transferred to a specialist centre where a MIBG scan confirmed the diagnosis. A right adrenalectomy was performed successfully. He made a good recovery with normalisation of his heart function and his diabetes resolved post operatively. The diagnosis was delayed for a few years due to his episodic symptoms being attributed to other more common diagnoses. The precipitating cause for the MI may have been due to the colonoscopy procedure which may have triggered a catecholamine surge by increasing the intraabdominal pressure. This patient’s colitis may have been due to intense splanchnic vasoconstriction and the acute coronary syndrome due to a type 2 NSTEMI. He also had a catecholamine cardiomyopathy due to his state of catecholamine excess. His coronary angiogram was normal. Although a rare diagnosis in itself, there are a few case reports in the literature of phaeochromocytoma presenting as a mimic of an acute coronary syndrome.