Abstract
The diagnosis of phaeochromocytoma may be delayed due to episodic and short-lasting forms of a phaeochromocytoma crisis and the otherwise presence of rather unspecific symptoms. We present an unusual case of a 28-year-old female with a history of thyroidectomy for familial medullary thyroid carcinoma who repeatedly presented to hospital with a normal heart rate and normal blood pressure after an anxiety attack, intermittent palpitations and hyperthermia. Two hours after admission to hospital for diagnostic clarification the patient was found in asystole and a successful resuscitation was performed. Massive pulmonary oedema, rhabdomyolysis and acute renal failure characterised the further clinical course. An adult respiratory distress syndrome developed. On the third day after admission a hypertensive crisis led to the diagnosis of phaeochromocytoma and multiple endocrine neoplasia (MEN) type IIA. After continuous haemofiltration, renal function was restored and the patient underwent removal of a tumour of the left adrenal gland which was 4cm in diameter. The sieve coefficient of myoglobin during continuous haemofiltration was 0.6-0.8. The patient was discharged in complete good health. This case exemplifies that all patients with medullary thyroid carcinoma should be screened for phaeochromocytoma on a routine basis.