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Boro H, Sharma H, Mittal D, Kaswan R, Saran D, Nagar N, Jakhar M, Goyal L, Saini S, Joshi V, Chugh S, Bundela V, Mannar V, Nagendra L, Agstam S. PHEOCHROMOCYTOMA, THE GREAT MASQUERADER, PRESENTING AS REVERSIBLE CARDIOMYOPATHY: PRIMUM NON NOCERE. Acta Endocrinol (Buchar) 2023; 19:370-375. [PMID: 38356978 PMCID: PMC10863964 DOI: 10.4183/aeb.2023.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background Pheochromocytoma, the great masquerader, can have a varied spectrum of clinical manifestations. It can often cause a diagnostic challenge despite the availability of modern investigation modalities. Case We present the case of a 38-year-old male who presented with uncontrolled hypertension for the past 10 years and heart failure for one year. The diagnosis of pheochromocytoma was missed in the initial setting, leading to a biopsy of the retroperitoneal mass. Fortunately, the patient survived the procedure. Subsequently, with the involvement of a multi-disciplinary team, he was optimized for surgery under strict cardiac monitoring. After the complete excision of the tumour, he showed significant improvement not only in his clinical symptoms but also in his cardiac status. Conclusions This case emphasizes the age-old medical phrase of 'Primum non nocere or first, do no harm'. Any invasive procedure in a pheochromocytoma can lead to a massive release of catecholamines causing a hypertensive crisis, pulmonary oedema, and even cardiac arrest. Any young patient presenting with hypertension or heart failure should be investigated for secondary causes. Cardiomyopathy due to pheochromocytoma is because of catecholamine overload and usually reverses or improves after curative surgery.
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Affiliation(s)
- H. Boro
- Department of Endocrinology and Metabolism, Aadhar Health Institute, Hisar, India
| | - H. Sharma
- Department of Surgery, Aadhar Health Institute, Hisar, India
| | - D. Mittal
- Department of Surgery, Aadhar Health Institute, Hisar, India
| | - R.S. Kaswan
- Department of Urology, Aadhar Health Institute, Hisar, India
| | - D.P. Saran
- Department of Cardiology, Aadhar Health Institute, Hisar, India
| | - N. Nagar
- Department of Anaesthesia and Intensive Care, Aadhar Health Institute, Hisar, India
| | - M.S. Jakhar
- Department of Anaesthesia and Intensive Care, Aadhar Health Institute, Hisar, India
| | - L. Goyal
- Department of Oncology, Aadhar Health Institute, Hisar, India
| | - S. Saini
- Department of Surgery, Aadhar Health Institute, Hisar, India
| | - V. Joshi
- Department of Surgery, Aadhar Health Institute, Hisar, India
| | - S. Chugh
- Department of Patholog,y Aadhar Health Institute, Hisar, India
| | - V. Bundela
- Department of Gastroenterology, Aadhar Health Institute, Hisar, India
| | - V. Mannar
- Aarupadai Veedu Medical College, Endocrinology unit, Department of Medicine, Puducherry, India
| | - L. Nagendra
- JSS Medical College, Department of Endocrinology, Mysuru, India
| | - S. Agstam
- VMMC and Safdarjung Hospital, Department of Cardiology, New Delhi, India
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