Pheochromocytoma: a case report of a rare culprit of heart failure in the peripartum period.

Background: Pheochromocytoma-induced acute cardiomyopathy in the peripartum period is a rare but potentially life-threatening maternofoetal condition. Its diagnosis and management present unique challenges due to non-specific clinical signs. We report a case of peripartum pheochromocytoma-induced adrenal crisis leading to acute heart failure with severely impaired left ventricular systolic function and resultant hypoxaemic respiratory failure. Case summary: A 30-year-old pregnant woman at term experienced spontaneous rupture of membranes and developed hypertension during labour, culminating in severe hypertension and pulmonary oedema with hypoxaemic respiratory failure following epidural anaesthesia. An emergency caesarean section was performed with intensive care admission for mechanical ventilation and vasopressor support. Initially suspected of having pre-eclampsia with peripartum cardiomyopathy, further evaluation with CT imaging revealed a large retroperitoneal mass, leading to the diagnosis of pheochromocytoma-induced adrenal crisis with reversible cardiomyopathy. Laparoscopic adrenalectomy confirmed the diagnosis, and her left ventricular function improved with her ejection fraction recovering from 30% to 55%. Discussion: Clinicians should maintain a high index of suspicion for pheochromocytoma in cases of unexplained severe pregnancy-related hypertension, especially when associated with acute heart failure or cardiomyopathy, and when typical signs of pre-eclampsia or peripartum cardiomyopathy are absent or incomplete. Early diagnosis through biochemical assays and imaging, combined with prompt multidisciplinary management, is crucial to optimizing maternal and foetal outcomes.