Pheochromocytoma crisis

What is the correct patient's diagnosis, and which is the most appropriate treatment?

1. A pheochromocytoma, treatment by tumor removal
2. A pheochromocytoma crisis, treatment by emergent tumor removal
3. A pheochromocytoma crisis, treatment by emergent tumor removal if vigorous pharmacological therapy fails
4. A pheochromocytoma, treatment by vigorous pharmacological therapy

A 49-year-old woman presented with a 1-day history of nausea. ECG showed anterior ST-segment elevations (V1–V6) (Figure A) and the troponin test was positive. Echocardiography disclosed anterior hypokinesia of the left ventricle with a left ventricular ejection fraction (LVEF) of 23%. The patient developed a cardiogenic shock accompanied by acute liver, kidney, and respiratory failures. Computed tomography showed an 8-cm right-sided adrenal mass with central necrosis (Figure B), which was removed in toto during emergency surgery (Figure C). Adrenergic crisis induced by a pheochromocytoma leads to life-threatening, catecholamine-induced hemodynamic disturbances. Successful treatment of a pheochromocytoma crisis demands prompt diagnosis, vigorous pharmacological therapy, and emergent tumor removal, if the patient continues to deteriorate.