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Epinephrine-Secreting Pheochromocytoma Presenting with Cardiogenic Shock and Profound Hypocalcemia
- Stephen W. Olson, MD;
- Leonard E. Deal, MD; and
- Michael Piesman, MD
- From Madigan Army Medical Center, Tacoma, WA 98431; U.S. Army Medical Department Center and School, Fort Sam Houston, TX 78234; and Walter Reed Army Medical Center, Washington, DC 20307.
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Editor's Note:The lead author of the following Clinical Observation was one of a dozen Associates of the American College of Physicians selected to present a clinical vignette at the 2002 Annual Session in Philadelphia. We are proud to present this case report through a special arrangement with the Council of Associates of the College.
TO THE EDITOR:
Background: Fewer than 10% of pheochromocytomas secrete predominantly epinephrine, which is 10 times more metabolically active than norepinephrine (1). Epinephrine-secreting pheochromocytomas are associated with high morbidity and mortality due to cardiogenic shock (2-10).
Objective: To demonstrate that hypocalcemia may contribute to cardiogenic shock in patients with an epinephrine-secreting pheochromocytoma.
Case Report: A 50-year-old man with no medical history presented with symptoms of intermittent weakness, abdominal pain, nausea, vomiting, and diaphoresis of 2 weeks' duration, along with progressive chest pain and shortness of breath of 8 hours' duration. His blood pressure was 70/0 mm …
