Transcatheter Adrenal Arterial Embolization for Life-Threatening Pheochromocytoma Crisis.

BACKGROUND

Pheochromocytoma crisis is a life-threatening endocrine emergency frequently complicated by Takotsubo syndrome (TTS) and cardiogenic shock. Hemodynamic stabilization is difficult to achieve with medical therapy alone, and emergency surgery carries high perioperative mortality.

CASE SUMMARY: A 50-year-old woman presented with acute chest pain, de Winter sign, basal-type TTS, and refractory cardiogenic shock with extreme blood pressure lability. Imaging revealed a 6.5 × 4.7 cm adrenal mass suspicious for pheochromocytoma. Despite optimal medical treatment, hemodynamic stability could not be achieved. Urgent transcatheter adrenal arterial embolization (TAAE) was performed as rescue therapy with sustained hemodynamic stabilization thereafter. After 1 month of alpha-blockade preparation, elective adrenalectomy was completed uneventfully. At the 1-year follow-up, the patient remained asymptomatic with normal cardiac function and no tumor recurrence.

CONCLUSIONS

In this case, TAAE served as a minimally invasive bridging measure for refractory pheochromocytoma crisis. The staged strategy combining TAAE with delayed elective adrenalectomy was associated with a favorable outcome.

TAKE-HOME MESSAGES: Extreme blood-pressure lability in a patient with TTS should prompt evaluation for occult pheochromocytoma. Urgent TAAE may serve as an effective bridge to delayed elective adrenalectomy for refractory pheochromocytoma crisis.