Failure of a-Methyltyrosine to Prevent Hypertensive Crisis in Pheochromocytoma

Ram, C. Venkata S.; Meese, Roderick B.; Hill, Stephen

doi:10.1001/archinte.1985.00360110190038

Cited by 15 publications

(2 citation statements)

References 6 publications

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“…[28][29][30] It is important to note, however, that hypertensive crises may still occur with metyrosine monotherapy. 31 When should add-on therapy be considered?…”

Section: Calcium Channel Antagonistsmentioning

confidence: 99%

Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma?

Challis

Casey

Simpson

et al. 2016

Clinical Endocrinology

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Phaeochromocytomas and paragangliomas (PPGLs) are catecholamine secreting neuroendocrine tumours that predispose to haemodynamic instability. Currently, surgery is the only available curative treatment, but carries potential risks including hypertensive and hypotensive crises, cardiac arrhythmias, myocardial infarction and stroke, due to tumoral release of catecholamines during anaesthetic induction and tumour manipulation. The mortality associated with surgical resection of PPGL has significantly improved from 20-45% in the early 20th century (Apgar & Papper, AMA Archives of Surgery, 1951, 62, 634) to 0-2·9% in the early 21st century (Kinney et al. Journal of Cardiothoracic and Vascular Anesthesia, 2002, 16, 359), largely due to availability of effective pharmacological agents and advances in surgical and anaesthetic practice. However, surgical resection of PPGL still poses significant clinical management challenges. Preoperatively, alpha-adrenoceptor blockade is the mainstay of management, although various pharmacological strategies have been proposed, based largely on reports derived from retrospective data sets. To date, no consensus has been reached regarding the 'ideal' preoperative strategy due, in part, to a paucity of data from high-quality evidence-based studies comparing different treatment regimens. Here, based on the available literature, we address the Clinical Question: Is there an optimal preoperative management strategy for PPGL?

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“…[28][29][30] It is important to note, however, that hypertensive crises may still occur with metyrosine monotherapy. 31 When should add-on therapy be considered?…”

Section: Calcium Channel Antagonistsmentioning

confidence: 99%

Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma?

Challis

Casey

Simpson

et al. 2016

Clinical Endocrinology

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“…Additional medications such as nitroprusside or magnesium or alpha methyl tyrosine should be considered in controlling hypertensive crisis induced by pheochromocytoma. While nitroprusside and alpha methyl tyrosine have reported the failure use in controlling hypertensive crises in association with pheochromocytoma,16, 17 magnesium may be a good choice in stabilizing the haemodynamic of the patient by decreasing catecholamine release 18. In our case, we supposed that magnesium may stabilise the patient from the hypertensive crisis but may fail to rescue the patient from rhabdomyolysis.…”

Section: Discussionmentioning

confidence: 99%

Continuous renal replacement therapy for haemodynamic collapse and rhabdomyolysis induced by pheochromocytoma crisis

et al. 2016

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Pheochromocytoma associated with pregnancy is not common. Caesarean section may induce pheochromocytoma crisis, resulting in a lethal condition. The clinical picture of pheochromocytoma crisis is extremely variable. In this report, we describe a case of severe pheochromocytoma crisis induced by caesarean section presenting with hyperpyrexia, haemodynamic collapse, muscle weakness, heart failure, and acute kidney injury. Furthermore, we report that the muscle weakness was a manifestation of rhabdomyolysis, resulting from the pheochromocytoma crisis. Standard medical therapy failed to halt the patient's rapidly deteriorating condition. Continuous renal replacement therapy removed catecholamines from the circulation, resulting in improvement of haemodynamics and abrogation of rhabdomyolysis.

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Metyrosine and Pheochromocytoma

Steinsapir

Aa²,

Lm³

et al. 1997

Arch Intern Med

139

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The combination of alpha-metyrosine and alpha-blockade results in better blood pressure control and less need for use of antihypertensive medication or pressors during surgery, compared with the classical method of single-agent adrenergic blockade. Preoperative treatment with metyrosine along with an alpha-blocker is a useful strategy for decreasing the surgical morbidity in patients with pheochromocytoma and assumes greater importance as long as the availability of phentolamine for intraoperative use is a problem.

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Failure of a-Methyltyrosine to Prevent Hypertensive Crisis in Pheochromocytoma

Cited by 15 publications

References 6 publications

Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma?

Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma?

Continuous renal replacement therapy for haemodynamic collapse and rhabdomyolysis induced by pheochromocytoma crisis

Metyrosine and Pheochromocytoma

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