Publication:

Pheochromocytoma crisis presenting as refractory cardiogenic shock: anaesthetic and critical care challenges

Pheochromocytoma is a rare catecholamine-secreting tumour of the adrenal medulla with heterogeneous clinical manifestations. Pheochromocytoma crisis is an uncommon but life-threatening presentation frequently complicated by cardiovascular collapse and multi-organ dysfunction. A 30-year-old male presented with undifferentiated shock, metabolic acidosis, acute heart failure, and renal failure. He was later diagnosed with pheochromocytoma-induced cardiogenic shock, likely worsened by inappropriate β-blocker therapy without prior α-blockade. Management required advanced critical care support, mechanical ventilation, renal replacement therapy, staged endocrine optimization, and definitive adrenalectomy. This case highlights the importance of maintaining a high index of suspicion for pheochromocytoma in patients with unexplained cardiogenic shock and labile hemodynamics, particularly when preceded by episodic headaches and inappropriate β-blocker exposure. Early imaging and multidisciplinary management are crucial for optimal outcomes.