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Adverse Drug Reactions in Patients with Phaeochromocytoma

Incidence, Prevention and Management

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Abstract

The dangers of phaeochromocytomas are mainly due to the capability of these neuroendocrine tumours to secrete large quantities of vasoactive catecholamines, thereby increasing blood pressure and causing other related adverse events or complications. Phaeochromocytomas are often missed, sometimes only becoming apparent during therapeutic interventions that provoke release or interfere with the disposition of catecholamines produced by the tumours. Because phaeochromocytomas are rare, evidence contraindicating use of specific drugs is largely anecdotal or based on case reports. The heterogeneous nature of the tumours also makes adverse reactions highly variable among patients. Some drugs, such as dopamine D2 receptor antagonists (e.g. metoclopramide, veralipride) and β-adrenergic receptor antagonists (β-blockers) clearly carry high potential for adverse reactions, while others such as tricyclic antidepressants seem more inconsistent in producing complications. Other drugs capable of causing adverse reactions include monoamine oxidase inhibitors, sympathomimetics (e.g. ephedrine) and certain peptide and corticosteroid hormones (e.g. corticotropin, glucagon and glucocorticoids). Risks associated with contraindicated medications are easily minimised by adoption of appropriate safeguards (e.g. adrenoceptor blockade). Without such precautions, the state of cardiovascular vulnerability makes some drugs and manipulations employed during surgical anaesthesia particularly dangerous. Problems arise most often when drugs or therapeutic procedures are employed in patients in whom the tumour is not suspected. In such cases, it is extremely important for the clinician to recognise the possibility of an underlying catecholamine-producing tumour and to take the most appropriate steps to manage and treat adverse events and clinical complications.

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Acknowledgements

The writing of this article was supported by the intramural programme of the National Institute of Neurological Disorders and Stroke and, the National Institute of Child Health and Human Development, at the National Institutes of Health, Bethesda, Maryland, USA.

The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Clinical Chemistry and Laboratory Medicine, and Department of Medicine, University of Dresden, Fetscherstr 74, O1307, Dresden, Germany

    Graeme Eisenhofer

  2. Pharmacy Department, Royal Hobart Hospital, Hobart, Tasmania, Australia

    Graham Rivers

  3. Department of Anaesthesiology, The Methodist Hospital, Houston, Texas, USA

    Alejandro L. Rosas

  4. Department of Anaesthesiology and Surgical Services, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, Maryland, USA

    Zena Quezado

  5. New York University Medical Center, New York, New York, USA

    William M. Manger

  6. National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA

    Karel Pacak

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  1. Graeme Eisenhofer
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  2. Graham Rivers
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  3. Alejandro L. Rosas
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  4. Zena Quezado
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Correspondence to Graeme Eisenhofer.

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Eisenhofer, G., Rivers, G., Rosas, A.L. et al. Adverse Drug Reactions in Patients with Phaeochromocytoma. Drug-Safety 30, 1031–1062 (2007). https://doi.org/10.2165/00002018-200730110-00004

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