A34-year-old woman presented with recurrent 15-minute episodes of palpitations, lightheadedness, and chest tightness. ECGs obtained during these episodes revealed striking global T-wave inversions that resolved spontaneously 2 hours after each episode (Figure 1⇓). Echocardiography revealed severe left ventricular dysfunction with an estimated ejection fraction of 20%. Cardiac catheterization demonstrated angiographically normal coronary arteries. A 24-hour urine collection for catecholamines showed an epinephrine level of 227 μg (normal, 2 to 24 μg) and a metanephrine level of 3803 μg (normal, 95 to 475 μg). Abdominal/pelvic MRI identified a right adrenal mass (Figure 2⇓). 123I-MIBG scintigram showed marked uptake in a single location corresponding to the right adrenal gland (Figure 3⇓). The patient was diagnosed with an epinephrine-secreting pheochromocytoma and underwent an uncomplicated right adrenalectomy (Figure 4⇓). Three months after surgery, the patient was asymptomatic. A repeat echocardiogram revealed normal ventricular function, and urine catecholamines remained negative.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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