When Zebras Collide: A Case of Synchronous Wolff-Parkinson-White Syndrome and Pheochromocytoma

Patient: Male, 36-year-old Final Diagnosis: Pheochromocytoma Symptoms: Chest discomfort • headache • shortness of breath • symptomatic tachyarrhythmia Medication: — Clinical Procedure: — Specialty: General and Internal Medicine OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Pheochromocytoma is a rare catecholamine-secreting tumor arising from chromaffin cells of the adrenal medulla. Wolff-Parkinson-White (WPW) pattern is a rare congenital cardiac conduction disorder in which 1 or more accessory pathways connects the atria and ventricles, bypassing the atrioventricular (AV) node. Patients with this type of accessory pathway who also experience pre-excitation evoked arrhythmias have what is termed WPW syndrome. Here, we present a patient with a WPW pattern who underwent surgical resection of a pheochromocytoma, review considerations relating to the perioperative management, and briefly summarize the hormonal effects of pheochromocytoma in a patient with a WPW accessory pathway. CASE REPORT: A man in his early 30’s with a history of hypertension developed shortness of breath with palpitations, was noted to have delta waves on electrocardiogram (ECG), and was given a diagnosis of WPW syndrome. Six years later, he developed headache, chest pain, and flank discomfort in addition to his daily palpitations and shortness of breath. Plasma catecholamine levels were measured and found to be elevated, and imaging studies noted the presence of a large right-sided adrenal mass, consistent with a pheochromocytoma. A decision was made to proceed with a laparoscopic right adrenalectomy, which was successful and uneventful. Through the 30-day postoperative period, he reported no further episodes of symptomatic palpitations for the first time in several years. CONCLUSIONS: To the best of our knowledge, this is only the fourth case in the literature describing pheochromocytoma with co-existing WPW syndrome. In our case, resection of the pheochromocytoma ameliorated the patient’s chronic WPW-related tachyarrhythmia.