Pheochromocytoma-induced Myocarditis: A Case Report and Literature Review

Abstract

Background: Pheochromocytoma is a rare catecholamine-secreting tumor that may present with various cardiovascular manifestations, including acute myocarditis. The excessive release of catecholamines can cause direct myocardial injury through mechanisms such as vasospasm, oxidative stress, and calcium overload, leading to myocardial inflammation and dysfunction. Case Presentation: We report the case of a 28-year-old woman with no prior history who presented with acute chest pain, hypotension, and elevated cardiac enzymes. Cardiac MRI revealed findings consistent with acute myocarditis. During hospitalization, she exhibited paroxysmal hypertension, tachycardia, and sweating, prompting an endocrine work-up. Imaging revealed a right adrenal mass, and urinary metanephrines were markedly elevated, confirming a diagnosis of pheochromocytoma. Following alpha-blockade, laparoscopic adrenalectomy was performed. At three-month follow-up, the patient showed complete normalization of cardiac function. Discussion: Pheochromocytoma-induced myocarditis remains a rare but potentially reversible form of myocardial injury. Cardiac MRI is crucial for identifying non-ischemic patterns of inflammation, while biochemical and imaging studies aid in establishing the underlying cause. Recent case reports emphasize the importance of considering pheochromocytoma in patients with atypical myocarditis, particularly when accompanied by labile blood pressure or adrenergic symptoms. Early diagnosis and surgical treatment typically result in favorable outcomes. Conclusion: This case illustrates the importance of including pheochromocytoma in the differential diagnosis of acute myocarditis. Awareness of this entity is essential, as timely identification and tumor resection can lead to full cardiac recovery. A multidisciplinary approach is crucial for optimal diagnosis and management.