A life-threatening case of pheochromocytoma crisis with hemodynamic instability.

BACKGROUND: Pheochromocytoma crisis (PCC) is a fatal disease characterized by hyper and/or hypotension, hyperthermia, and encephalopathy, and its diagnosis and treatment are challenging.

CASE PRESENTATION: A 50-year-old woman presented with hypertension, and computed tomography showed an adrenal tumor. Fever, shock, and impaired consciousness were observed, and PCC was diagnosed clinically. Systolic blood pressure fluctuated from 40-220 mmHg within a few minutes, and circulatory agonists were adjusted accordingly. The blood pressure changes gradually stabilized with α-blockade. Surgery was performed on hospital day 26, and the pathological diagnosis was consistent with a pheochromocytoma. She was discharged on hospital day 37.

CONCLUSION: Computed tomography may facilitate early diagnosis in the acute phase of PCC in case of limited patient medical information and insufficient time to wait for a definitive diagnosis using traditional hormone tests. The shock requires pharmacological therapy to maintain circulation, and paradoxically, the administration of α-blockade can be lifesaving.