Recurrent Ventricular Tachycardia in Malignant Metastatic Pheochromocytoma

A 34-year-old man presented with monomorphic ventricular tachycardia (VT) accompanying syncope (Figure 1A). Frequent episodes of sustained VT after paroxysmal elevation of heart rate and blood pressure were noted during his stay in the intensive care unit. He had no family or personal history of syncope or cardiac arrest. Coronary angiography and echocardiographic examination revealed no significant abnormalities. Chest and adrenal computed tomography scans revealed a left adrenal mass (7.2×5.3 cm), lymph node enlargement, and several pulmonary nodules (Figure 2A–2D). Elevated levels of 24-hour urinary catecholamines (Figure 3) and abnormal uptake on I-123 metaiodobenzylguanidine (MIBG) imaging (Figure 2E) suggested a malignant pheochromocytoma with lymph node and pulmonary metastasis.Figure 1. A , The initial ECG showed very rapid monomorphic ventricular tachycardia (VT) with right bundle-branch block morphology and left-axis deviation. B , Nonsustained and sustained ventricular tachycardia recurred although the patient was treated with an α-blocker. C , Pulseless sustained VT accompanied by syncope developed when the oral β-blocker was skipped immediately after the adrenalectomy. D , Implantable cardioverter-defibrillator interrogation showed successful termination of fast …