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Abstract

Background: Phaeochromocytoma, on its own, is a rare endocrine condition. Patient that presents with cardiogenic shock as a result of phaeochromocytoma-induced Takotsubo cardiomyopathy is even rarer, as phaeochromocytoma classically presents with hypertension. Clinical awareness and understanding of this disease entity is important for early identification and appropriate management of this endocrine emergency. Case presentation: A 39-year-old woman presented with one day history of repeated vomiting associated with epigastric pain. Her condition deteriorated rapidly with acute cardiac and renal failure with cardiogenic shock after intravenous fluid infusion, requiring high flow oxygen and high dose inotropic support in intensive care unit. Subsequent workup confirmed diagnosis of phaeochromocytoma-induced Takotsubo cardiomyopathy. Her condition of cardiomyopathy had been tied over by combined effort of inotropic support, use of intra-aortic balloon pump and intravensous fluid in the acute phase for haemodynamic stabilization. Her renal function was normalized on day 3 and left ventricular systolic function was normalized on day 10. Alpha and beta blockade were sequentially added and she underwent adrenalectomy with peri-operative infusion of magnesium sulphate. Post-operatively, she had an uneventful course and was able to wean off anti-hypertensive medications. Conclusion: Phaeochromocytoma presenting with cardiogenic shock is a very uncommon clinical condition, but its early identification is important for relevant management strategies. Through illustration of this clinical case with special highlight of her young age, tachycardia and clinical features of Takotsubo cardiomyopathy, this clinical experience can be shared for lifesaving management.

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