Rarely the first sign of a pheochromocytoma in a patient may be shock with multi-organ failure (MOF). Emergency surgery can be life saving.


Precipitating event: hemorrhagic necrosis of the tumor with a massive release of catecholamines


Signs and symptoms:

(1) hypotension

(2) headache

(3) sweating

(4) tachycardia with palpitations

(5) pallor with cold extremities

(6) nervousness and/or tremor

(7) acute abdominal pain with or without chest pain

(8) fatigue

(9) nausea and vomiting

(10) rhinitis

(11) afebrile


The absence of hypertension is a common reason why the diagnosis is not considered.


Multiple organ failures may include:

(1) renal failure

(2) respiratory failure

(3) pancreatitis

(4) lactic acidosis

(5) disseminated intravascular coagulopathy (DIC)

(6) rhabdomyolysis

(7) hepatic failure


The patient often is hemodynamically stable and does need vasopressor or inotropic support.


Differential diagnosis:

(1) septic shock

(2) stimulant overdose

(3) fulminant viral infection


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