"Pheochromocytoma crisis with refractory Acute Respiratory Distress Syndrome (ARDS), Takotsubo syndrome, emergency adrenalectomy, and need for Extracorporeal Membrane Oxygenation (ECMO) in a previously undiagnosed and asymptomatic patient, due to the use of metoclopramide"

作者全名："Xie, Yuhua; Zhang, An; Qi, Min; Xiong, Bin; Zhang, Suhua; Zhou, Jianzhong; Cao, Yunxing"

作者地址："[Xie, Yuhua; Zhang, An; Qi, Min; Xiong, Bin; Cao, Yunxing] Chongqing Med Univ, Affiliated Hosp 2, Dept Crit Care Med, Chongqing, Peoples R China; [Zhang, Suhua] Chongqing Med Univ, Affiliated Hosp 1, Dept Endocrinol, Chongqing, Peoples R China; [Zhou, Jianzhong] Chongqing Med Univ, Affiliated Hosp 1, Dept Cardiovasc Med, Chongqing, Peoples R China"

通信作者："Cao, YX (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Dept Crit Care Med, Chongqing, Peoples R China."

来源：BMC ENDOCRINE DISORDERS

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001025832600002

JCR分区：Q3

影响因子：2.8

年份：2023

卷号：23

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Acute respiratory distress syndrome; Critical care ultrasonic examination; Emergency adrenalectomy; Pheochromocytoma crisis; Veno-arterial extracorporeal membrane oxygenation

摘要："BackgroundPheochromocytoma (PCC) crisis is a rare life-threatening endocrine emergency. The diagnosis and treatment of PCC crisis, with acute respiratory distress syndrome (ARDS) as the first manifestation, is highly challenging, and traditional PCC management strategies are no longer suitable for these patients.Case presentationA 46-year-old female patient was admitted to the Intensive Care Unit (ICU) following sudden-onset acute respiratory distress and subsequent initiation of mechanical ventilation via endotracheal intubation. She was initially suspected of having a PCC crisis through the bedside critical care ultrasonic examination protocol. The computed tomography examination revealed a left adrenal neoplasm of 6.5cm x 5.9cm. The plasma-free metanephrine level was 100 times higher than the reference value. These findings were compatible with her PCC diagnosis. Alpha-blockers and fluid intake were started immediately. The endotracheal intubation was removed on the 11th day after admission to the ICU. The patient progressed to severe ARDS again, and invasive ventilation and continuous renal replacement therapy were needed. Despite aggressive therapy, her condition deteriorated. Therefore, she underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO)-assisted emergency adrenalectomy after multidisciplinary discussion. Postoperatively, the patient was supported by VA-ECMO for 7days. She was discharged from the hospital on day 30 after tumor resection.ConclusionsThis case highlighted the challenges in diagnosing and managing ARDS associated with PCC crisis. The traditional preoperative preparation protocol and optimal operation timing for patients with PCC are not suitable for patients with PCC crisis. Patients with life-threatening PCC crisis may benefit from early tumor removal, and VA-ECMO could maintain hemodynamic stability during and after surgery."

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