Pheochromocytoma and Paraganglioma

To the Editor: Neumann et al. (Aug. 8 issue)¹ review the current practices for management of pheochromocytoma. One aspect of presentation and management that was not emphasized in this review is that patients with these tumors may have acute hemodynamic instability and end-organ damage — that is, the so-called pheochromocytoma crisis.² Hypertensive crisis is well recognized and is mentioned in the review, but other forms of crisis occur, including cardiac crisis, which manifests clinically as a mimic of acute coronary syndrome or as cardiomyopathy with congestive cardiac failure.³ Pheochromocytoma crisis may also mimic septic shock; some patients have fever, hypotension, . . .