Abstract #1396724: Cryptic Catecholamines

The textbook presentation of a pheochromocytoma is the pentad severe headache, palpitations, significant perspiration, hypertension (HTN), and pallor. However, many patients present with subclinical findings, adding to challenge for physicians make this diagnosis. following case unusual in patient’s history three procedures under general anesthesia, one being an ablation 2019. A review previous CT images showed adrenal adenoma from This demonstrates that pheochromocytomas may have biochemically silent periods further complicating diagnosis management pheochromocytoma. 78-year-old female presents s/p elective atrial tachycardia. PMH remarkable T2D, HTN, hypothyroidism, CAD, fibrillation/AVNRT. In 2019 patient had first without any complications related blood pressure fluctuations. Due unknown reasons, persistent atypical fibrillation dyspnea, plan redo worsening symptoms shortness breath. Then 2022 underwent second developed labile initial findings 77/48 signs cardiogenic shock subsequent pulmonary edema. hypovolemia secondary development shock, required vasopressors. was started on beta-blockade response vasopressor treatment, which caused her increase significantly, systolic pressures ranging between 230-240. metoprolol stopped, transitioned doxazosin, due high suspicion Initial stabilization BP achieved after starting alpha blockade. remained somewhat but continued downward trend doxazosin. later ordered appreciable left mass. Past imaging records mass been since Metanephrine labs were collected found be 6332 pg/ml, confirming stabilized doxazosin adequate volume resuscitation then tight control pressure. Her hospital course proved difficult prior comorbidities age, she ultimately discharged three-week stay. vast majority AFib chronic HTN. There are different etiologies including more uncommon cause, pheochromocytomas. Common as follows: sweating, anxiety, also common presentations AFib. Long-term would improve significantly if screenings done presenting symptomatic Afib Positive screening initiate early consisting short blockade followed by chronic, low-dose beta patient, might contributed failure treatments persistence fibrillation.