Pre-operative tachycardia is not always a sign of sepsis or pain: a case report of pheochromocytoma

Fitriardi Sejati (Department of Surgery, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.)
Jasmine S Dzakira (Medical Professional Program, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia)
Esyl F Rahma (Medical Professional Program, Faculty of Medicine, Universitas Jenderal Achmad Yani, Cimahi, Indonesia.)

Acta Medical and Health Sciences (AMHS)
Vol. 4 No. 3 (2026): Acta Medical and Health Sciences

Pre-operative tachycardia is a frequent clinical manifestation commonly attributed to pain, anxiety, or systemic infection.1,2 However, uncommon endocrine emergencies such as pheochromocytoma may present with nonspecific cardiovascular instability and remain clinically unrecognized until catastrophic perioperative deterioration occurs.3,4 This case report describes a 26-year-old female who presented with a painful hyperemic right breast mass accompanied by persistent tachycardia and respiratory distress. In accordance with CARE case report principles, clinical data were retrospectively collected from medical records, including serial hemodynamic monitoring, laboratory investigations, electrocardiography, thoracic imaging, perioperative management, and intensive care interventions. Initial evaluation demonstrated persistent tachycardia (153 bpm), tachypnea, and hypertensive episodes that were disproportionate to the localized breast pathology. Despite surgical intervention and initial postoperative stabilization, the patient developed progressive hemodynamic instability characterized by persistent tachyarrhythmia, a Burch-Wartofsky Point Scale score of 20, severe hyperglycemia (858 mg/dL), ketonuria, and electrolyte imbalance, which eventually culminated in asystolic cardiac arrest. This constellation of cardiovascular and metabolic abnormalities strongly suggested a pheochromocytoma crisis precipitated by surgical stress and excessive catecholamine release.1,3,4 Catecholamine-induced insulin resistance and impaired peripheral glucose utilization likely contributed to the profound metabolic derangement observed in this patient.5,6 This case underscores the importance of recognizing unexplained perioperative tachycardia and hyperglycemia as potential indicators of occult pheochromocytoma.7–9 Early endocrine evaluation and appropriate perioperative preparation are critical to prevent fatal cardiovascular complications and improving surgical outcomes.   DOI : 10.35990/amhs.v4n3.p151-158   REFERENCES Nazari MA, Rosenblum JS, Haigney MC, Rosing DR, Pacak K. Pathophysiology and Acute Management of Tachyarrhythmias in Pheochromocytoma: JACC Review Topic of the Week. 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