Pheochromocytoma is a catecholamine-producing neuroendocrine neoplasm classically associated with secondary hypertension. We describe the case of a 63-year-old male who presented with intermittent precordial discomfort, paroxysmal hypertensive episodes, and a mild rise in cardiac troponin levels. He was referred to our institution with a presumptive diagnosis of acute coronary syndrome. Serial admission electrocardiograms showed no dynamic ischemic changes, and transthoracic echocardiography demonstrated preserved global systolic function without regional wall motion abnormalities. A noninvasive ischemic workup was therefore planned. Before performing coronary computed tomographic angiography (CCTA), the patient received propranolol, after which he developed a hypertensive crisis accompanied by recurrent precordial pain; an identical episode occurred following a second beta-blocker dose. CCTA ruled out flow-limiting coronary artery stenoses. In view of the clinical context, pheochromocytoma was suspected. Contrast-enhanced abdominal computed tomography identified a left adrenal mass, and urinary metanephrines were elevated. The patient underwent adrenalectomy, and histopathological examination confirmed a benign pheochromocytoma. Postoperative recovery was uneventful, and the patient remains asymptomatic at follow-up.

Measurement of androstenedione (4-AD) and 17α-hydroxyprogesterone (17-OHP) in blood is crucial for diagnosing and monitoring endocrine disorders such as congenital adrenal hyperplasia (CAH), which results from enzymatic defects in the steroidogenesis pathway. CAH patients require lifelong hormone replacement therapy to manage adrenal insufficiency and control androgen excess. Microsampling offers a less invasive alternative to frequent venous blood sampling, particularly in paediatric CAH patients, and enables at-home monitoring. Including 11-ketotestosterone (11-KT), an emerging biomarker in CAH, further enhances the clinical relevance of this approach. Liquid chromatography-tandem mass spectrometry-based methods were established and fully validated for the determination of 4-AD, 17-OHP and 11-KT in plasma, blood and 20 μL dried blood microsamples collected by volumetric absorptive microsampling (VAMS). For VAMS samples, we paid particular attention to robustness regarding storage and hematocrit to support future home sampling applications. The method's applicability was evaluated by assessing the agreement with plasma as the reference matrix for steroid hormone determination. A robust extraction procedure was developed, ensuring consistent recoveries across storage conditions and hematocrits (0.20 - 0.60 L/L). The method was successfully validated for 4-AD, 17-OHP and 11-KT in VAMS, blood and plasma samples, achieving lower limits of quantification of 30, 144 and 81 pg/mL in VAMS samples, respectively. Accuracy and precision were within 6.6% and 14.0% for all matrices. VAMS samples remained stable for up to one week at room temperature and after postal sending. A proof-of-concept study showed that plasma concentrations can reliably be derived from VAMS concentrations, when taking into account the hematocrit.

Pheochromocytoma is a rare catecholamine-secreting tumor that can cause major cardiovascular complications, including acute heart failure, arrhythmias, and stress-induced cardiomyopathy. Takotsubo syndrome (TTS) is an acute non-ischemic cardiomyopathy characterized by transient left ventricular systolic dysfunction without obstructive coronary artery disease, often mimicking acute coronary syndrome. Catecholamine excess plays a central role in its pathophysiology, leading to myocardial stunning, hemodynamic instability, and arrhythmias. The association between pheochromocytoma and TTS is uncommon and frequently associated with severe clinical presentations. We report the case of a 52-year-old woman with poorly controlled hypertension treated with a calcium channel blocker, who presented with chest pain, dyspnea, and palpitations. On admission, blood pressure was 178/122 mmHg, and heart rate was 102 bpm. The patient described recurrent episodes of headache and palpitations occurring two to three times monthly and lasting 30 to 60 minutes, suggesting secondary hypertension. Electrocardiography showed 1 mm ST-segment elevation in the anterior leads without reciprocal changes and a prolonged QTc interval (480 ms). Peak high-sensitivity troponin reached 1880 ng/L (reference <35 ng/L), while brain natriuretic peptide (BNP) was 450 pg/mL (reference <125 pg/mL). Transthoracic echocardiography revealed a left ventricular ejection fraction of 45% with apical akinesia and basal hyperkinesia, consistent with Takotsubo syndrome. Left ventriculography confirmed typical apical ballooning, and coronary angiography showed no obstructive coronary artery disease. During hospitalization, the patient developed rapid atrial fibrillation with hemodynamic instability, requiring electrical cardioversion and amiodarone therapy. Labile blood pressure and paroxysmal symptoms raised suspicion of catecholamine excess, subsequently confirmed by elevated plasma and urinary metanephrines. Abdominal CT identified a 30 × 25 × 28 mm left adrenal mass with attenuation >10 HU and intense heterogeneous contrast enhancement, highly suggestive of pheochromocytoma. Preoperative treatment with phenoxybenzamine was progressively titrated to achieve hemodynamic stabilization before surgical resection. After surgery, left ventricular systolic function completely recovered, with ejection fraction improving to 58%. At the sixth-week follow-up, plasma and urinary metanephrines had normalized, confirming complete biochemical remission and successful tumor removal. Blood pressure also normalized postoperatively. This case highlights the importance of considering pheochromocytoma in patients with Takotsubo syndrome complicated by severe arrhythmias or labile hypertension, as early diagnosis may improve management and prognosis.

Dysregulation of physiological stress systems, including the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS), is considered the pathway that links child maltreatment with psychopathology. However, how child maltreatment is linked with the coordination of the HPA axis and ANS stress responses remains unclear, particularly during the critical developmental period such as adolescence. This study investigated the association between the HPA axis indexed by cortisol and the ANS indexed by cardiovascular stress responses among adolescents with and without child maltreatment. The Childhood Trauma Questionnaire was administered to 116 adolescents (59 in the child maltreatment group and 57 in the comparison group), who took part in the Trier Social Stress Test during which their cortisol, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) reactivity were collected. Results showed that after controlling for age, sex, body mass index, and socioeconomic status, a symmetry between the HPA axis and ANS stress response marked by significantly positive relationships between cortisol reactivity and SBP and DBP reactivity was found in the comparison group, while an asymmetry between the HPA axis and ANS stress response marked by a negative association between cortisol reactivity and DBP reactivity and a null association between cortisol reactivity and SBP reactivity was observed in the child maltreatment group. These findings suggest that child maltreatment disrupts the symmetry between the HPA axis and ANS stress response in adolescents.