Pheochromocytoma crisis presenting as refractory cardiogenic shock: anaesthetic and critical care challenges

Pankaj Soni; Sai Siva Ramakrishna Nandavarapu; Rajeev Kumar

doi:10.18203/2320-6012.ijrms20261716

Authors

Pankaj Soni Department of Anaesthesiology and Critical Care, EMC Hospital, Amritsar, Punjab, India
Sai Siva Ramakrishna Nandavarapu Department of Anaesthesiology and Critical Care, EMC Hospital, Amritsar, Punjab, India
Rajeev Kumar Department of Anaesthesiology and Critical Care, EMC Hospital, Amritsar, Punjab, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20261716

Keywords:

Pheochromocytoma, Cardiogenic shock, Stress cardiomyopathy, β-blockers, Anesthesia, Critical care

Abstract

Pheochromocytoma is a rare catecholamine-secreting tumour of the adrenal medulla with heterogeneous clinical manifestations. Pheochromocytoma crisis is an uncommon but life-threatening presentation frequently complicated by cardiovascular collapse and multi-organ dysfunction. A 30-year-old male presented with undifferentiated shock, metabolic acidosis, acute heart failure, and renal failure. He was later diagnosed with pheochromocytoma-induced cardiogenic shock, likely worsened by inappropriate β-blocker therapy without prior α-blockade. Management required advanced critical care support, mechanical ventilation, renal replacement therapy, staged endocrine optimization, and definitive adrenalectomy. This case highlights the importance of maintaining a high index of suspicion for pheochromocytoma in patients with unexplained cardiogenic shock and labile hemodynamics, particularly when preceded by episodic headaches and inappropriate β-blocker exposure. Early imaging and multidisciplinary management are crucial for optimal outcomes.

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