Epinephrine-Secreting Pheochromocytoma Presenting with Cardiogenic Shock and Profound Hypocalcemia
Authors: Stephen W. Olson, Leonard E. Deal, Michael Piesman
Journal: Annals of Internal Medicine (2004)

Letters18 May 2004Epinephrine-Secreting Pheochromocytoma Presenting with Cardiogenic Shock and Profound HypocalcemiaStephen W. Olson, MD, Leonard E. Deal, MD, and Michael Piesman, MDStephen W. Olson, MDFrom 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., Leonard E. Deal, MDFrom 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., and Michael Piesman, MDFrom 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.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-10-200405180-00033 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Cryer PE. Physiology and pathophysiology of the human sympathoadrenal neuroendocrine system. N Engl J Med. 1980;303:436-44. [PMID: 6248784] CrossrefMedlineGoogle Scholar2. Richmond J, Frazer SC, Millar DR. Paroxysmal hypotension due to an adrenaline-secreting phaeochromocytoma. Lancet. 1961;2:904-6. [PMID: 14492017] CrossrefMedlineGoogle Scholar3. French C, Campagna FA. Pheochromocytoma with shock, marked leukocytosis, and unusual electrocardiograms. Case report and review of the literature. Ann Intern Med. 1961;55:127-34. [PMID: 13701725] LinkGoogle Scholar4. Shaw TR, Rafferty P, Tait GW. Transient shock and myocardial impairment caused by phaeochromocytoma crisis. Br Heart J. 1987;57:194-8. [PMID: 3814455] CrossrefMedlineGoogle Scholar5. Ramsay ID, Langlands JH. Phaeochromocytoma with hypotension and polycythaemia. Lancet. 1962;2:126-8. [PMID: 14490201] CrossrefMedlineGoogle Scholar6. Northfield TC. Cardiac complications of phaeochromocytoma. Br Heart J. 1967;29:588-93. [PMID: 4226390] CrossrefMedlineGoogle Scholar7. Takabatake T, Kawabata M, Ohta H, Yamamoto Y, Ishida Y, Hara H, et al . Acute renal failure and transient, massive proteinuria in a case of pheochromocytoma. Clin Nephrol. 1985;24:47-9. [PMID: 4017298] MedlineGoogle Scholar8. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 45-1989. A 48-year-old woman with acute respiratory failure and a left suprarenal mass. N Engl J Med. 1989;321:1316-29. [PMID: 2797104] CrossrefMedlineGoogle Scholar9. Ferguson KL. Imipramine-provoked paradoxical pheochromocytoma crisis: a case of cardiogenic shock. Am J Emerg Med. 1994;12:190-2. [PMID: 8161395] CrossrefMedlineGoogle Scholar10. Manger WM, Gifford RW. Clinical and Experimental Pheochromocytoma. Malden, MA: Blackwell Science; 1996. Google Scholar11. Lehmann G, Deisenhofer I, Ndrepepa G, Schmitt C. ECG changes in a 25-year-old woman with hypocalcemia due to hypoparathyroidism. Hypocalcemia mimicking acute myocardial infarction. Chest. 2000;118:260-2. [PMID: 10893393] CrossrefMedlineGoogle Scholar12. Lang RM, Fellner SK, Neumann A, Bushinsky DA, Borow KM. Left ventricular contractility varies directly with blood ionized calcium. Ann Intern Med. 1988;108:524-9. [PMID: 3248127] LinkGoogle Scholar13. Zaloga GP. Ionized hypocalcemia during sepsis [Editorial]. Crit Care Med. 2000;28:266-8. [PMID: 10667544] CrossrefMedlineGoogle Scholar14. Naot D, Callon KE, Grey A, Cooper GJ, Reid IR, Cornish J. A potential role for adrenomedullin as a local regulator of bone growth. Endocrinology. 2001;142:1849-57. [PMID: 11316750] CrossrefMedlineGoogle Scholar15. Hinson JP, Kapas S, Smith DM. Adrenomedullin, a multifunctional regulatory peptide. Endocr Rev. 2000;21:138-67. [PMID: 10782362] MedlineGoogle Scholar16. Kjeldsen SE, Weder AB, Egan B, Neubig R, Zweifler AJ, Julius S. Effect of circulating epinephrine on platelet function and hematocrit. Hypertension. 1995;25:1096-105. [PMID: 7737722] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: 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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