Preoperative Metyrosine Administration for Bilateral Pheochromocytomas Following Pheochromocytoma Crisis: A Case Report.

Introduction: Pheochromocytoma crisis complicated by catecholamine-induced cardiomyopathy is a life-threatening condition requiring careful preoperative management. Although metyrosine has recently been approved in Japan for the perioperative management of pheochromocytoma, clinical experience remains limited. Case Presentation: A 46-year-old man presented with pheochromocytoma crisis complicated by reverse Takotsubo cardiomyopathy and was diagnosed with bilateral pheochromocytomas. Given the preceding life-threatening crisis, severe cardiac dysfunction, marked catecholamine excess, and bilateral disease, he was considered at high perioperative risk. Metyrosine was added to conventional α-adrenergic blockade before one-stage bilateral adrenalectomy. Metyrosine was well tolerated, and total urinary metanephrine decreased by approximately 76% without symptomatic hypotension. Although intraoperative blood pressure fluctuations still occurred, bilateral adrenalectomy was completed successfully. Conclusion: This case supports the feasibility of preoperative metyrosine administration in a high-risk patient. Although its effect on intraoperative hemodynamic stability remains uncertain, metyrosine may be considered as an adjunct to conventional α-adrenergic blockade in carefully selected patients.