{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:42:39Z","timestamp":1776231759097,"version":"3.50.1"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Pheochromocytoma is a rare neuroendocrine tumor characterized by excessive catecholamine secretion, typically presenting with hypertension, headache, palpitations, and sweating. Giant pheochromocytomas (commonly defined as tumors with diameter &amp;gt;4-6cm) are even rarer and may lead to severe cardiovascular complications, including catecholamine-induced cardiomyopathy and thromboembolic events. We report the case of a 76-year-old female who presented with acute pulmonary embolism and heart failure as the initial features of a giant pheochromocytoma, with concurrent deep vein thrombosis and catecholamine- induced cardiomyopathy. Laboratory tests revealed markedly elevated catecholamine metabolites, while imaging confirmed a right adrenal mass measuring 11.1\u00d77.9 cm, along with bilateral pulmonary artery emboli and left lower extremity deep vein thrombosis. After multidisciplinary evaluation, the patient was managed with \u03b1- and \u03b2-blockers, anticoagulation, and subsequent surgical resection of the tumor. Postoperative follow-up showed significant improvement in cardiac function and complete resolution of thrombotic events. This case demonstrates the importance of including pheochromocytoma in the differential diagnosis of patients with unexplained thromboembolism or cardiovascular collapse, particularly when an adrenal mass is identified on imaging. Early diagnosis, multidisciplinary management, and timely intervention are crucial for favorable outcomes in such complex and life-threatening presentations.<\/jats:p>","DOI":"10.3389\/fonc.2026.1772112","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T04:42:55Z","timestamp":1776228175000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A rare initial presentation of giant pheochromocytoma: a case report of acute pulmonary embolism complicated by catecholamine-induced cardiomyopathy"],"prefix":"10.3389","volume":"16","author":[{"given":"Lujing","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Jining Medical University","place":["Jining, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanqing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Jining Medical University","place":["Jining, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Jining Medical University","place":["Jining, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruguang","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Jining Medical University","place":["Jining, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Jining Medical University","place":["Jining, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuanfang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Jining Medical University","place":["Jining, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Jining Medical University","place":["Jining, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-025-02639-9","article-title":"Global epidemiology of pheochromocytoma: a systematic review and meta-analysis of observational studies","volume":"48","author":"Vitturi","year":"2025","journal-title":"J Endocrinol Invest"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa965","article-title":"Incidence and clinical presentation of pheochromocytoma and sympathetic paraganglioma: a population-based study","volume":"106","author":"Ebbehoj","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B3","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1530\/eje-20-0628","article-title":"Epidemiology of pheochromocytoma and paraganglioma: population-based cohort study","volume":"184","author":"Leung","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.ejim.2018.01.015","article-title":"Incidence of pheochromocytoma and sympathetic paraganglioma in the Netherlands: a nationwide study and systematic review","volume":"51","author":"Berends","year":"2018","journal-title":"Eur J Intern Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1433582","article-title":"Pheochromocytoma: an updated scoping review from clinical presentation to management and treatment","volume":"15","author":"Saavedra","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2026.1774131","article-title":"Natural history of large adrenal tumors","volume":"17","author":"Macech","year":"2026","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s12957-019-1765-7","article-title":"Clinical analysis of adrenal lesions larger than 5\u2009cm in diameter (an analysis of 251 cases)","volume":"17","author":"Zhang","year":"2019","journal-title":"World J Surg Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocpiqo.2017.11.002","article-title":"Clinical, biochemical, and radiological characteristics of a single-center retrospective cohort of 705 large adrenal tumors","volume":"2","author":"I\u00f1iguez-Ariza","year":"2018","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-149-5-200809020-00007","article-title":"Systematic review: the Trousseau syndrome revisited: should we screen extensively for cancer in patients with venous thromboembolism","volume":"149","author":"Carrier","year":"2008","journal-title":"Ann Intern Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1055\/a-0669-9556","article-title":"Catecholamine-induced cardiomyopathy in pheochromocytoma: how to manage a rare complication in a rare disease","volume":"51","author":"Santos","year":"2019","journal-title":"Horm Metab Res"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1186\/s13578-024-01314-5","article-title":"Revisiting Virchow's triad: exploring the cellular and molecular alterations in cerebral venous congestion","volume":"14","author":"Zhou","year":"2024","journal-title":"Cell Biosci"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15763","article-title":"Importance of catecholamine signaling in the development of platelet exhaustion after traumatic injury","volume":"20","author":"Matthay","year":"2022","journal-title":"J Thromb Haemost"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn311282-20200629-00482","article-title":"Expert consensus on the diagnosis and treatment of pheochromocytoma and paraganglioma (2020 edition)","volume":"36","year":"2020","journal-title":"Chin J Endocrinol Metab"},{"key":"B14","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1210\/endrev\/bnab019","article-title":"Personalized management of pheochromocytoma and paraganglioma","volume":"43","author":"N\u00f6lting","year":"2022","journal-title":"Endocr Rev"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1772112\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T04:43:15Z","timestamp":1776228195000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1772112\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":14,"alternative-id":["10.3389\/fonc.2026.1772112"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1772112","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]},"article-number":"1772112"}}