A 28-year-old woman complained of chest discomfort. Her blood pressure was 120/80 mmHg and heart rate 110/min. She had elevated cardiac enzymes with troponin I of 13.0 ng/mL, creatinine kinase 819 U/L, creatinine kinase–MB 99 U/L. ECG showed significant ST depression in V4-6. Glycosuria was found and her fasting blood glucose was 199 mg/dL. Cardiac CT angiography revealed normal coronary artery ( Fig. 1A ). Echocardiography showed hypokinesis of mid to basal segments of left ventricle (LV) with preservation of apex showing inverted-Takotsubo pattern ( Fig. 1B , left sided: diastole, right sided: systole). LV ejection fraction (EF) was 25%. Cardiac magnetic resonance imaging showed dilated cardiomyopathy with hypokinesis of basal and mid-ventricle and sparing of apex ( Fig. 1C left sided: diastole, right sided: systole). There was mild high signal intensity in T2W black blood image ( Fig. 1D ) and no late gadolinium enhancement ( Fig. 1E ). Based on tachycardia, hyperglycemia, glycosuria and abnormal LV motion, we checked abdomen CT under suspicion of pheochromocytoma-induced cardiomyopathy, revealing a 6.4 cm × 6 cm sized right adrenal mass with prominent vascularity ( Fig. 1F ). Plasma test found markedly elevated norepinephrine of 13.80 (0.07–0.4 ng/mL) and epinephrine 0.71 (0.04–0.2 ng/mL). 24-hr urine collection demonstrated the elevation of norepinephrine (1618.0 μg, 15–80), epinephrine (137.0 μg, 1.2–20), metanephrine (8.2 μg, 0.2–1.2), and vanillylmandeic acid (33.7 mg, 1–5).
