Pheochromocytoma Presents as Takotsubo Cardiomyopathy

A hypertensive crisis, with an acute heart failure and pulmonary oedema had complicated anesthesia induction, during an elective surgery was done to an elderly aged patient. This patient had hypertension, with a very controlled BP on Irbesartan (angiotensin receptor blocker), and a normal cardiac function before admission. The operation was aborted, and the patient was resuscitated in the theatre and the ICU. Investigations showed cardiomegaly on CXR, with abnormal size and function of the Lt Ventricle on echocardiograph, as well as high levels of serum troponin, and very high values of serum catecholamine's metabolites (metanephrines and normetanephrines). A high suspicion of pheochromacytoma was raised, and this was confirmed later by the presence of a large RT adrenal mass on abdominal CT scan and MIBG scan. After 3 weeks of supportive treatment in the ICU, with continuous monitoring of the very labile BP, the patient underwent a laparoscopic adrenalectomy. Postoperatively, the patient's BP and cardiac function were restored