Clozapine: A Mimicry of Phaeochromocytoma

Li, June K.Y.; Yeung, V. T. F.; Leung, C. M.; Chow, C. C.; Ko, Gary T.C.; So, Winnie K.W.; Cockram, C. S.

doi:10.3109/00048679709065519

Cited by 22 publications

(22 citation statements)

References 4 publications

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“…6,7,8 Their ages ranged from 22 -44 years. All patients had a diagnosis of schizophrenia, with various combinations of refractory positive and negative psychotic symptoms, as well as several failed antipsychotic trials prior to the initiation of clozapine.…”

Section: Pseudophaeochromocytoma Associated With Clozapine Therapy: Amentioning

confidence: 99%

Pseudophaeochromocytoma associated with Clozapine Therapy: a case report

Akinsola

Ong

2011

Afr. J. Psych

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Section: Pseudophaeochromocytoma Associated With Clozapine Therapy: Amentioning

confidence: 99%

Pseudophaeochromocytoma associated with Clozapine Therapy: a case report

Akinsola

Ong

2011

Afr. J. Psych

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“…Instead, they suggested that clozapine's action might have a role in increasing the fusion of noradrenaline storage vesicles within the nerve axon. Hypertension has been described in as many as 4% of patients taking clozapine [6] which may be accounted for by the blockage of alpha-2-adrenreceptors [1, 2, 7]. Raised levels of noradrenaline may then spill over from the central nervous system into the plasma, which in turn will be present in urine, giving rise to the clinical features and biochemical abnormalities highlighted in our and previous cases.…”

Section: Discussionmentioning

confidence: 64%

“…In all, six previous cases [1–3] were found comprising of five males and one female with ages ranging 27–44 years. The duration of clozapine therapy varied from two months to eighteen months.…”

Section: Discussionmentioning

confidence: 99%

Clozapine Use Presenting with Pseudopheochromocytoma in a Schizophrenic Patient: A Case Report

Sara

Jenkins

Chohan

et al. 2013

Case Reports in Endocrinology

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Introduction. There have been six previous cases that reported pseudopheochromocytoma in patients taking clozapine. Our case showed the direct link of clozapine to serum levels of certain markers. Case. This is a case of a 49-year-old obese Caucasian female who was referred to endocrinology for investigation of Cushing's syndrome, based on raised blood pressure and Cushingoid facies. The patient had underlying schizophrenia and was stable on clozapine. Her blood pressure was 150/99 mmHg on bendroflumethiazide and candesartan. We measured her 24-hour urinary-free cortisol, which was normal but 24-hour urinary-free noradrenaline was elevated at 835 nmol (76–561) with normal adrenaline 36 nmol (7–82) and dopamine 2679 nmol (366–2879), as the patient had history of palpitations and sweating. Two sets of 24-hour urinary-free cortisol measurements were normal and serum cortisol suppressed to <50 nmol/l after a 1 mg overnight dexamethasone. Two further 24-hour urinary-free catecholamines showed a raised level of noradrenaline. MRI demonstrated normal adrenals and MIBG scan did not show any abnormal uptake at adrenal glands. Conclusion. Pseudopheochromocytoma has been reported in patients taking clozapine. A number of different mechanisms for raised plasma noradrenaline levels with clozapine have been postulated. The above case highlights an unusual but known side effect of clozapine.

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“…Elevation of the plasma noradrenaline level has been reported as a consistent clinical effect of clozapine, which is due to its potent effect on α2-adrenergic receptors [1][2][3]. Paradoxical hypertension with an elevated concentration of urinary catecholamines has also been reported in association with clozapine treatment, although rarely, and in association with other antipsychotic medications [13]. Here we present a patient with paranoid schizophrenia that was treated with clozapine and developed laboratory mimicking pheochromocytoma.…”

Section: Introductionmentioning

confidence: 76%

A Case of Pseudopheochromocytoma Associated with Clozapine Therapy

Gurkan¹

2014

J Psychiatry

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Background: An elevated plasma noradrenaline level is a consistent clinical effect of clozapine, which is due to its potent effect on α2-adrenergic receptors. Clozapine, a tricyclic dibenzodiazepine derivative, is used to treat refractory schizophrenia. In this report we present a case of pseudopheochromocytoma in a schizophrenic patient treated with clozapine. Case: A 55-year-old female diagnosed with schizophrenia referred from psychiatry clinic to endocrinology clinic detected with bilateral adrenal masses. She was hypertensive and she used nifedipine. Urine catecholamines, especially normetanephrine, were extremely elevated; however, she did not have any pheochromocytoma-related symptoms. Adrenal imaging was not compatible with pheochromocytoma. Following psychiatric consultation, clozapine was withdrawn for 1 week, and then 24-h urine catecholamineswere normal. Metaiodobenzylguanidine (MIBG) scan was normal. Conclusion: Given the potentially significant morbidity associated with paranoid schizophrenia, especially in undiagnosed cases, we recommend timely urinary catecholamine screening in patients that develop hypertension or other typical symptoms following the use of clozapine.

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Clozapine: A Mimicry of Phaeochromocytoma

Abstract: Clozapine may induce sympathetic hyperactivity.

Cited by 22 publications

References 4 publications

Pseudophaeochromocytoma associated with Clozapine Therapy: a case report

Pseudophaeochromocytoma associated with Clozapine Therapy: a case report

Clozapine Use Presenting with Pseudopheochromocytoma in a Schizophrenic Patient: A Case Report

A Case of Pseudopheochromocytoma Associated with Clozapine Therapy

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