Pheochromocytoma crisis combined with median arcuate ligament syndrome - A rare case report

Sep 30, 2026

Uploaded by Blitz

Left ventricular thrombus from acute catecholamine cardiomyopathy combined with pheochromocytoma crisis (PC) is extremely rare, and concurrent median arcuate ligament syndrome (MALS) has not been previously reported. A 45-year-old woman presented with severe abdominal pain, vomiting, rapid blood pressure fluctuations, and recurrent hypotensive syncope. Diagnosis integrated enhanced chest-abdominal CT, 24-hour ambulatory blood pressure monitoring, coronary angiography, and hormone assays, leading to catecholamine cardiomyopathy, PC, and MALS.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Introduction

® Clinical Case Report Pheochromocytoma crisis combined with median arcuate ligament syndrome A rare case report Jiang-xiong Wen, MMa , Wen-jia Li, MDb , Jing Guo, BMc , Hongnaly Siliath, BMd , Yun Xiao, MMe ,* | Abstract
Rationale: Left ventricular thrombus caused by acute catecholamine cardiomyopathy combined with pheochromocytoma crisis (PC) is extremely rare in clinical practice, and there are no reports of patients with median arcuate ligament syndrome (MALS) at the same time. This report describes the case of a 45-year-old woman admitted to the cardiology department with this rare condition. The patient presented with severe abdominal pain, vomiting, rapid blood pressure (BP) fluctuations, and recurrent hypotensive syncope. We discuss the patient’s diagnosis and treatment and share our experience with this patient.
Patient concerns: A combination of PC and MALS has not been previously reported. This successful treatment provides a reference for the future treatment of similar patients, filling a related gap. The treatment methods and outcomes are the most important aspects of patient care.
Diagnoses: The patient was admitted to the hospital because of chest tightness, headache, abdominal pain, and several episodes of syncope for 4 days. Clinical symptoms, combined with enhanced chest-abdominal computed tomography, 24-hour ambulatory BP monitoring, left and right coronary angiography, and renin-angiotensin-aldosterone and adrenocorticotropic hormone-cortisol measurements, led to a diagnosis of catecholamine cardiomyopathy, PC, and MALS.
Interventions: Continuous invasive arterial and venous BP monitoring, norepinephrine was administered via an intravenous pump, and intravenous crystalloid infusions were administered to improve the patient’s significant BP fluctuations. Subsequently, after a gradual improvement in BP fluctuations, an alpha receptor blocker (phenoxybenzamine) was administered orally, and the dose was gradually increased to the target dose to control BP. Finally, after 6 months of optimized medical treatment, the right adrenal tumor was safely resected with complete recovery of cardiac structure and function.
Outcomes: During the 6-month follow-up, after the operation, the patient’s BP was stable without medication, hypotensivesyncope, recurrence of abdominal pain, and tumor recurrence. Key laboratory test results, such as cardiac Troponin I, N-terminal pro-B-type natriuretic peptide, white blood cell, adrenocorticotropic hormone, cortisol, etc, returned to normal levels Lessons: First, it highlights the effectiveness of norepinephrine in treating BP fluctuations and hypotensive syncope in patients with pheochromocytoma. Second, we propose a potential pathological interaction between pheochromocytoma and MALS, thereby avoiding surgical treatment of MALS. Third, it confirmed the safety of delayed surgery in patients with high-risk cardiac conditions.
Abbreviations: BP = blood pressure, CT = computed tomography, HR = heart rate, LVEF = left ventricular ejection fraction, MALS = median arcuate ligament syndrome, NE = norepinephrine, PC = pheochromocytoma crisis, PHEO = pheochromocytoma. | | --- | | Keywords: blood pressure fluctuations, catecholamine cardiomyopathy, median arcuate ligament syndrome, pheochromocytoma crisis | The authors have no funding and conflicts of interest to disclose. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. a Department of Cardiovascular Internal Medicine, The First People’s Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science Technology, Kunming, Yunnan, China, b Department of Radiology, The First People’s Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science Technology, Kunming, Yunnan, China, c Department of Medical Intensive Care Unit, The First People’s Hospital of Yunnan Province, Affiliated Hospital of Kunming Universit

FAQs

What rare condition combination is described in this case report?

The report describes pheochromocytoma crisis (PC) combined with median arcuate ligament syndrome (MALS), along with catecholamine cardiomyopathy.

How was the diagnosis established in the 45-year-old patient?

Diagnosis used clinical symptoms plus enhanced chest-abdominal CT, 24-hour ambulatory blood pressure monitoring, coronary angiography, and renin-angiotensin-aldosterone and adrenocorticotropic hormone-cortisol measurements.

What treatment strategy led to recovery?

The patient received continuous invasive arterial/venous blood pressure monitoring, norepinephrine infusion and crystalloid support for blood pressure instability, followed by oral phenoxybenzamine with dose titration. After six months of optimized medical treatment, the right adrenal tumor was safely resected with complete recovery of cardiac function.

Sep 30, 2026

Uploaded by Blitz