Cheng H, Gu LT, Yang J. Pheochromocytoma presenting with vomiting and heart failure: A case report. World J Cardiol 2025; 17(8): 110366 [DOI: 10.4330/wjc.v17.i8.110366]
Corresponding Author of This Article
Jing Yang, PhD, Department of Cardiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, Jiangsu Province, China. jingyang_cardio@163.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Aug 26, 2025; 17(8): 110366 Published online Aug 26, 2025. doi: 10.4330/wjc.v17.i8.110366
Pheochromocytoma presenting with vomiting and heart failure: A case report
Han Cheng, Ling-Tong Gu, Jing Yang
Han Cheng, Ling-Tong Gu, Jing Yang, Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Author contributions: All authors contributed to the study conception and design. Original draft preparation was conducted by Cheng H; Writing, reviewing and editing of the draft manuscript was completed by Yang J, Gu LT and Cheng H; All authors commented on previous versions of the manuscript; All authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82200353; Jiangsu Province Double Innovation Doctoral Program, No. JSSCBS20221948; Suzhou Gusu Health Talent Program, No. (2022)043; Suzhou Gusu Health Talent Plan Talent Research Project, No. GSWS2022014; Suzhou Science and Technology Innovation Policy Funding Project; the Jiangsu Province College Students’ Innovation and Entrepreneurship Training Program Project, No. 202410285087Z; and “Bo Xi” Talent Casting Plan of the First Affiliated Hospital of Soochow University.
Informed consent statement: Informed consent was obtained from the patient for the use of their medical information.
Conflict-of-interest statement: All authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Yang, PhD, Department of Cardiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, Jiangsu Province, China. jingyang_cardio@163.com
Received: June 5, 2025 Revised: June 20, 2025 Accepted: July 22, 2025 Published online: August 26, 2025 Processing time: 77 Days and 14.9 Hours
Abstract
BACKGROUND
Pheochromocytoma, a rare catecholamine-secreting tumor, typically presents with the classic triad of headache, palpitations, and diaphoresis, often accompanied by cardiovascular manifestations. While vomiting occurs in approximately 34.5% of cases, it is rarely the predominant and persistent presenting symptom. Pheochromocytoma-induced cardiomyopathy leading to heart failure is a recognized but uncommon complication. Due to its heterogeneous presentations, misdiagnosis and diagnostic delay are frequent.
CASE SUMMARY
A 53-year-old female presented predominantly with persistent and refractory vomiting as her chief complaint, accompanied by signs of acute heart failure [left ventricular ejection fraction (LVEF) 30%]. Initial evaluation at a primary hospital, including coronary angiography (revealing only mild stenosis), led to a misdiagnosis of coronary artery disease. Despite standard anti-thrombotic, anti-heart failure, and anti-emetic therapy, her vomiting persisted and heart failure did not resolve. Subsequent hospitalization revealed dramatic paroxysmal hypertension (202/129 mmHg to 97/51 mmHg) and fever. Significantly elevated plasma metanephrines and normetanephrine, combined with abdominal computed tomography and magnetic resonance imaging, confirmed a right adrenal pheochromocytoma. This diagnosis was significantly delayed due to the atypical prominence of gastrointestinal symptoms masking the underlying endocrine crisis.
CONCLUSION
This case highlights a highly atypical presentation of pheochromocytoma dominated by refractory vomiting and complicated by acute catecholamine-induced cardiomyopathy. It emphatically underscores that pheochromocytoma must be considered in the differential diagnosis for patients presenting with unexplained, treatment-resistant vomiting, particularly when co-existing with acute heart failure. The presence of labile hypertension, even if not initially evident, provides a crucial diagnostic clue. Prompt biochemical screening (catecholamine metabolites) and adrenal imaging are essential to prevent diagnostic delay and enable timely, life-saving surgical intervention.
Core Tip: This case highlights an exceptionally atypical presentation of pheochromocytoma dominated by refractory vomiting and complicated by acute catecholamine-induced cardiomyopathy with heart failure (left ventricular ejection fraction 30%). Initial misdiagnosis as coronary artery disease occurred due to mild stenosis on angiography. The critical diagnostic clue emerged with dramatic paroxysmal hypertension (fluctuating from 202/129 mmHg to 97/51 mmHg). This report underscores that pheochromocytoma must be considered in patients with unexplained treatment-resistant vomiting coexisting with acute heart failure, particularly when labile hypertension appears. Timely biochemical screening (catecholamine metabolites) and adrenal imaging are essential to prevent life-threatening delays.
