Pseudophaeochromocytoma associated with Clozapine Therapy: a case report

Akinsola, O J; Ong, K

doi:10.4314/ajpsy.v14i5.9

Cited by 7 publications

(6 citation statements)

References 4 publications

(5 reference statements)

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“…The clinical effects of urine catecholamines remain uncertain. Some researchers have reported there are clinical effects [18,19], whereas others have reported there are no clinical effects, as in the presented patient [20]. Similar to the presented case, Li et al [13] reported a 27year-old male with mimicking pheochromocytoma; their patient used clozapine to treat catatonic schizophrenia, and developed hypertension and elevated urinary catecholamines.…”

Section: Discussionsupporting

confidence: 69%

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 Following psychiatric consultation, clozapine was withdrawn for 1 week, and then 24-h urine catecholamineswere normal.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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Section: Discussionsupporting

confidence: 69%

A Case of Pseudopheochromocytoma Associated with Clozapine Therapy

Gurkan¹

2014

J Psychiatry

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“…The hypertension was accompanied by rise in urinary E and NE, to which all 3 anomalies subsided after interventions were introduced and CLZ was discontinued (Li et al, 1997 ). Paroxysmal hypertension was diagnosed, as with multiple other case reports of CLZ-associated hypertension and raised urinary catecholamines (Krentz et al, 2001 ; Akinsola and Ong, 2011 ; Sara et al, 2013 ). In addition to hypertension, Akinsola and Ong ( 2011 ) reported tachycardia of 140 bpm in a patient and Krentz et al ( 2001 ) reported 3 cases of accelerated HR ranging from 104 to 130 bpm.…”

Section: Resultsmentioning

confidence: 68%

Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review

et al. 2018

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Background: Clozapine is the antipsychotic of choice for treatment-resistant schizophrenia and has minimal risk for extrapyramidal symptoms. Therapeutic benefits, however, are accompanied by a myriad of cardiometabolic side-effects. The specific reasons for clozapine's high propensity to cause adverse cardiometabolic events remain unknown, but it is believed that autonomic dysfunction may play a role in many of these.Objective: This systematic review summarizes the literature on autonomic dysfunction and related cardiovascular side effects associated with clozapine treatment.Method: A search of the EMBASE, MEDLINE, and EBM Cochrane databases was conducted using the search terms antipsychotic agents, antipsychotic drug*, antipsychotic*, schizophrenia, schizophren*, psychos*, psychotic*, mental ill*, mental disorder*, neuroleptic*, cardiovascular*, cardiovascular diseases, clozapine*, clozaril*, autonomic*, sympathetic*, catecholamine*, norepinephrine, noradrenaline, epinephrine, adrenaline.Results: The search yielded 37 studies that were reviewed, of which only 16 studies have used interventions to manage cardiovascular side effects. Side effects reported in the studies include myocarditis, orthostatic hypotension and tachycardia. These were attributed to sympathetic hyperactivity, decreased vagal contribution, blockade of cholinergic and adrenergic receptors, reduced heart rate variability and elevated catecholamines with clozapine use. Autonomic neuropathy was identified by monitoring blood pressure and heart rate changes in response to stimuli and by spectral analysis of heart rate variability. Metoprolol, lorazepam, atenolol, propranolol, amlodipine, vasopressin and norepinephrine infusion were used to treat tachycardia and fluctuations in blood pressure, yet results were limited to case reports.Conclusion: The results indicate there is a lack of clinical studies investigating autonomic dysfunction and a limited use of interventions to manage cardiovascular side effects associated with clozapine. As there is often no alternative treatment for refractory schizophrenia, the current review highlights the need for better designed studies, use of autonomic tests for prevention of cardiovascular disease and development of novel interventions for clozapine-induced side effects.

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“…CLZ was discontinued resulting in normalization of blood pressure and urinary catecholamine concentration. 85 – 87 This evidence suggests the need for routine urinary catecholamine screening and blood pressure monitoring.…”

Section: Resultsmentioning

confidence: 99%

Rare and very rare adverse effects of clozapine

Fazio¹,

Gaetano²,

Caroleo³

et al. 2015

NDT

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Clozapine (CLZ) is the drug of choice for the treatment of resistant schizophrenia; however, its suitable use is limited by the complex adverse effects’ profile. The best-described adverse effects in the literature are represented by agranulocytosis, myocarditis, sedation, weight gain, hypotension, and drooling; nevertheless, there are other known adverse effects that psychiatrists should readily recognize and manage. This review covers the “rare” and “very rare” known adverse effects of CLZ, which have been accurately described in literature. An extensive search on the basis of predefined criteria was made using CLZ and its combination with adverse effects as keywords in electronic databases. Data show the association between the use of CLZ and uncommon adverse effects, including ischemic colitis, paralytic ileus, hematemesis, gastroesophageal reflux disease, priapism, urinary incontinence, pityriasis rosea, intertriginous erythema, pulmonary thromboembolism, pseudo-pheochromocytoma, periorbital edema, and parotitis, which are influenced by other variables including age, early diagnosis, and previous/current pharmacological therapies. Some of these adverse effects, although unpredictable, are often manageable if promptly recognized and treated. Others are serious and potentially life-threatening. However, an adequate knowledge of the drug, clinical vigilance, and rapid intervention can drastically reduce the morbidity and mortality related to CLZ treatment.

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Pseudophaeochromocytoma associated with Clozapine Therapy: a case report

Cited by 7 publications

References 4 publications

A Case of Pseudopheochromocytoma Associated with Clozapine Therapy

A Case of Pseudopheochromocytoma Associated with Clozapine Therapy

Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review

Rare and very rare adverse effects of clozapine

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