A rare case of pheochromocytoma-induced reverse Takotsubo cardiomyopathy presenting as a catecholaminergic crisis.

purposePheochromocytoma is a rare neuroendocrine tumor that may present with atypical and potentially life-threatening cardiovascular manifestations due to catecholamine excess. Reverse Takotsubo cardiomyopathy, a distinct form of stress-induced cardiomyopathy, has been strongly associated with catecholamine crisis but remains underrecognized. The purpose of this report is to describe a rare case of pheochromocytoma-induced reverse Takotsubo cardiomyopathy complicated by acute severe mitral regurgitation and to emphasize the importance of early endocrine recognition. CASE PRESENTATION: A 40-year-old woman presented with hypertensive emergency, acute chest pain, electrocardiographic changes suggestive of acute coronary syndrome, and markedly elevated cardiac biomarkers. Transthoracic echocardiography revealed reduced left ventricular ejection fraction with basal and mid-ventricular akinesis, apical hyperkinesis, and acute severe mitral regurgitation consistent with reverse Takotsubo cardiomyopathy. Emergency coronary angiography demonstrated normal coronary arteries. CLINICAL FINDINGS AND OUTCOME: Recurrent stress-induced cardiomyopathy in a young patient without conventional cardiovascular risk factors, accompanied by autonomic symptoms, hyperglycemia, and lactic acidosis, raised suspicion of pheochromocytoma-related catecholamine crisis. Cross-sectional imaging identified a left adrenal mass and biochemical testing confirmed markedly elevated plasma metanephrines. After appropriate preoperative α-adrenergic blockade, laparoscopic adrenalectomy resulted in complete clinical and biochemical remission with full recovery of cardiac function.

conclusionPheochromocytoma should be considered in younger patients presenting with recurrent or atypical Takotsubo cardiomyopathy, particularly in the case of reverse pattern and when associated with acute mitral regurgitation or hypertensive emergency. Early endocrine diagnosis is critical as definitive surgical treatment leads to complete resolution and prevents recurrence of severe cardiovascular complications.