When NSTEMI is not coronary disease: MINOCA revealing pheochromocytoma
https://doi.org/10.15605/jafes.041.S1
- Author:
Shaleela Mohd Esha
1
;
Hazwani Aziz
1
;
Elliyyin Katiman
1
Author Information
1. Hospital Tengku Permaisuri Norashikin, Kajang
- Publication Type:Journal Article
- MeSH:
MINOCA;
Non-ST Elevated Myocardial Infarction;
Pheochromocytoma
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):22-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Pheochromocytoma is a catecholamine-secreting tumor
with diverse cardiovascular manifestations, including
myocardial infarction with non-obstructive coronary
arteries (MINOCA). We report a case of biochemically
confirmed pheochromocytoma initially presenting as
non-ST-elevation myocardial infarction (NSTEMI), later
reclassified as MINOCA.
Case:A 62-year-old female with type 2 diabetes mellitus and
hypertension was admitted with presumed NSTEMI and
commenced on dual antiplatelet therapy. Further history
revealed recurrent presyncope associated with paroxysmal headache, palpitations, and profuse diaphoresis.
During admission, her blood pressure was markedly
labile, ranging from 75/45 to 220/122 mmHg, raising
suspicion of pheochromocytoma. Biochemical evaluation
demonstrated markedly elevated 24-hour urinary
normetanephrine of 36.19 µmol/day (reference 0–2.13)
and methoxytyramine of 3.90 µmol/day (reference 0.10–
1.79), consistent with catecholamine excess. Dedicated
adrenal computed tomography identified a 3.8-cm right
adrenal lesion with high attenuation (44 Hounsfield Unit
[HU]), arterial enhancement (119 HU), and low washout
(absolute 40%, relative 24%), without calcification or
necrosis. Electrocardiography showed sinus rhythm with
T-wave inversion in leads I, aVL, and V5–V6. Transthoracic
echocardiography demonstrated a preserved left
ventricular ejection fraction of 67% without regional wallmotion abnormalities. Coronary angiography subsequently
showed normal coronary arteries, supporting a diagnosis of
MINOCA likely secondary to pheochromocytoma-related
catecholamine excess and hypertensive crisis. Antiplatelets
were discontinued. She was commenced on α-blockade,
with additional felodipine and low-dose β-blocker for
blood pressure optimization, and subsequently underwent
successful open right adrenalectomy. Postoperatively, she
required transient inotropic support but was weaned within
36 hours.
Conclusion:Pheochromocytoma-associated MINOCA is uncommon
but important to recognize. Catecholamine surges may
cause myocardial injury through coronary vasospasm, myocardial oxygen supply-demand mismatch, and direct
catecholamine-mediated cardiotoxicity. Recognition is
crucial, as management differs fundamentally from atherosclerotic acute coronary syndrome and requires α-blockade
before β-blockade.
- Full text:2026072813151737843EP_A007.pdf
