Case Report Life-Saving Emergency Adrenalectomy in a Pheochromocytoma Crisis with Cardiogenic Shock Thalia Bekelaar , 1 Gervais Nougon, 2 Marc Peters, 2 Frederic De Roeck, 1 Steven Haine, 1 Dirk Ysebaert, 3 Maarten Spinhoven, 4 Philippe G. Jorens , 5 Rudi De Paep, 5 and Frederik Lahaye 5 1 Department of Cardiology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium 2 Department of Emergency Medicine, Sint-Jozef Hospital, Malle, Belgium 3 Department of Hepatobiliary-Transplantation-Endocrine Surgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium 4 Department of Radiology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium 5 Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium Correspondence should be addressed to Philippe G. Jorens; philippe.jorens@uza.be Received 23 September 2020; Accepted 27 February 2021; Published 18 March 2021 Academic Editor: Ertugrul Ercan Copyright © 2021 Thalia Bekelaar et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cardiogenic shock during a pheochromocytoma crisis is a life-threatening disorder. This case report illustrates a 49-year-old male with profound cardiogenic shock, extreme hemodynamic instability (systolic blood pressure ranging from 45 up to 290 mmHg in a cyclic pattern), and progressive multiple organ failure in the presence of a unilateral adrenal mass. Emergency adrenalectomy led to rapid hemodynamic stabilization. Histological investigation confirmed the diagnosis of pheochromocytoma. This case indicates that emergency adrenalectomy, although usually not considered first choice, is a valid option in cardiogenic shock and extremely fluctuating hemodynamics due to a pheochromcytoma-induced catecholamine storm. 1. Introduction A pheochromocytoma crisis is an acute, life-threatening con- dition [1–3]. Excessive catecholamine release can cause hemo- dynamic instability, multiple organ failure, and cardiogenic shock. The primary underlying mechanism is activation of alpha-adrenergic receptors, which induces arterial vasocon- striction, reduced end-organ perfusion, and tissue ischemia [1]. The best treatment strategy during an acute crisis is still unclear, but hemodynamic stabilization prior to intervention is considered most appropriate. We present a case in whom emergency adrenalectomy of a (presumed) pheochromocy- toma during cardiogenic shock led to a quick recovery. 2. Case Presentation A 49-year-old male patient presented at the emergency room of the referring hospital with hematemesis and abdominal pain. The previous medical history included active smoking, epileptic seizures treated with lamotrigine, and an ischemic stroke treated with aspirin and simvastatin. Clinical examination showed a tender abdomen. His vital signs at initial evaluation were an oxygen saturation of 85% on room air, a blood pressure of 177/125 mmHg, pulse rate 127 bpm, body temperature 37.3 ° C, and Glasgow coma scale of 15/15. Arterial blood gas analysis revealed a pH of 7.25, with a paO 2 of 52 mmHg, paCO 2 of 33 mmHg, a marked elevated serum lactate 7.2 mmol/L (normal value <2:2 mmol/L), and a low bicarbonate level 14 mmol/L (nor- mal range 21–26 mmol/L). Due to progressive respiratory failure with hypoxemia and hypercapnia, the patient was intubated in the emergency room. Laboratory data showed an increased hemoglobin level of 18.8 g/dL (normal range 13.5-17.0 g/dL) and leukocytosis of 30:6 × 10 9 /L (normal range 4.3–9:6 × 10 9 /L) with a normal CRP (<5 mg/L). Acute renal failure with a creatinine of 2.5 mg/dL (normal range Hindawi Case Reports in Cardiology Volume 2021, Article ID 8848893, 4 pages https://doi.org/10.1155/2021/8848893