Reversal of severe cardiac systolic dysfunction caused by pheochromocytoma in a heart transplant candidate

Whenever a patient is evaluated as a possible candidate for heart transplantation, potential causes of reversible cardiomyopathy must always be considered. Although rare, it is well-known that pheochromocytoma can result in a dilated cardiomyopathy, which can be partially or completely reversible. We report a case of a 33-year-old woman with heart failure that was caused by a severe dilated cardiomyopathy who was referred for urgent heart transplant evaluation. The diagnosis of bilateral adrenal pheochromocytomas was made, and within 3 weeks of medical therapy, left ventricular systolic dysfunction completely reversed, avoiding the need for heart transplantation. The patient later underwent successful adrenalectomy. Unique features of this case of pheochromocytoma-induced cardiomyopathy include (1) serial norepinephrine measurements over 3 weeks documenting the efficacy of medical therapy, (2) unique cutaneous manifestations that resolved with medical therapy, and (3) familial multiple endocrine neoplasia syndrome with medullary carcinoma of the thyroid in three generations of this patient's family.