Cardiac failure due to epinephrine-secreting pheochromocytoma: clinical, laboratory and pathological findings in a sudden death

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.01.021 Byline: Stefano D'Errico, Cristoforo Pomara, Irene Riezzo, Margherita Neri, Emanuela Turillazzi, Vittorio Fineschi Keywords: Pheochromocytoma; Cardiac failure; Sudden death; Epinephrine dosage; Heart morphology Abstract: A rare case of cardiac failure due to hypertensive crisis in pheochromocytoma in a 25-year-old young man is presented. In the Emergency Department the patient complained of persisting headache and vomiting; he was distressed but fully alert, his heart rate was 110b/min and blood pressure 180/80mmHg. Few hours after admission, the clinical course suddenly got worse with signs and symptoms of fatal cardiac shock (dyspnoea, cyanosis, pulmonary oedema, hypocontractility of left ventricle). Autopsy revealed a large tumour of the left adrenal gland. Histological examination confirmed macroscopic suspicion of pheochromocytoma. Catecholamine serum levels were analysed by high pressure liquid chromatography (HPLC) with electrochemical detection. The urine contained 35[mu]g/24h norepinephrine and 184[mu]g/24h epinephrine (normal range [less than or equal to]64 and [less than or equal to]36[mu]g/24h respectively). These laboratory findings impressively demonstrate that the tumour was active, secreting high levels of epinephrine. Cardiac failure due to an acute catecholamine-related hypertensive crisis was established as the cause of death. Author Affiliation: Department of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Viale degli Aviatori, no. 1, 71100 Foggia, Italy Article History: Received 22 September 2008; Revised 19 January 2009; Accepted 29 January 2009