Phaeochromocytoma Crisis Presenting As Inverted Takotsubo Cardiomyopathy in a Young Woman: A Successful Outcome.

Phaeochromocytoma crisis is a rare, life-threatening endocrine emergency characterised by profound haemodynamic instability and multiorgan dysfunction. We report the case of a previously healthy 31-year-old woman who presented with sudden-onset cardiopulmonary decompensation, marked blood-pressure variability, pulmonary oedema, and cardiogenic shock, with biochemical evidence of myocardial injury. Echocardiography demonstrated apical hypercontractility with akinesia of the basal and midventricular segments and a left ventricular ejection fraction of 28%, consistent with reverse takotsubo cardiomyopathy. Cross-sectional imaging revealed a large 9 cm left adrenal mass, which, together with markedly elevated plasma and urinary metanephrines, confirmed the diagnosis of phaeochromocytoma crisis. The patient required mechanical ventilation, vasoactive support, and intra-aortic balloon counterpulsation. Following successful resuscitation and stabilisation with α- and β-adrenergic blockade, she underwent elective laparoscopic left adrenalectomy. Histopathological examination confirmed a high-risk phaeochromocytoma, while genetic testing was negative. Postoperatively, metanephrine concentrations normalised and bi-ventricular cardiac function recovered completely. This case highlights the importance of considering phaeochromocytoma crisis in patients presenting with otherwise unexplained haemodynamic instability and stress cardiomyopathy. Early recognition, multidisciplinary critical care, appropriate adrenergic blockade, and timely definitive surgery are essential and can be lifesaving.