Risk of catecholaminergic crisis following glucocorticoid administration in patients with an adrenal mass: a literature review.
Clin Endocrinol (Oxf)
; 83(5): 622-8, 2015 Nov.
Article
en En
| MEDLINE
| ID: mdl-25940577
ABSTRACT
BACKGROUND:
Glucocorticoids as diagnostic or therapeutic agents have been reported to carry an increased risk of catecholaminergic crisis (CC) in patients with pheochromocytoma or paraganglioma (PPGL).METHODS:
We searched literature databases using the following terms pheochromocytoma, paraganglioma, adrenal incidentaloma, steroids, glucocorticoids, dexamethasone suppression test (DST), hypertensive crisis, cosyntropin and CRH. From all published case reports (1962-2013), we reviewed medical history, presenting symptoms, dose and route of steroid administration, location and size of adrenal mass, biochemical phenotype and outcome.RESULTS:
Twenty-five case reports describing a CC were identified. Three patients with an adrenal incidentaloma suffered a CC following high-dose DST, and in one case, this was fatal. In two of these patients, biochemical testing missed the diagnosis, and in the third, a DST was done despite elevated urinary metanephrines. No CC has been reported for patients undergoing a low-dose DST. Three of 16 patients who received therapeutic glucocorticoids and four of six patients following cosyntropin testing died. No specific biochemical phenotype was related to adverse events.CONCLUSIONS:
Although a causal relationship cannot be established from this review, it seems prudent to exclude a PPGL in patients with a large incidentaloma or when high-dose DST is considered in a patient with an incidentaloma of any size. Our literature review does not support the need for biochemical testing for PPGL prior to a low-dose (1 mg) DST. Finally, before starting therapeutic glucocorticoids, any clinical signs or symptoms of a potential PPGL should prompt reliable biochemical testing to rule out a PPGL.
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Feocromocitoma
/
Dexametasona
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Neoplasias de las Glándulas Suprarrenales
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Glucocorticoides
Tipo de estudio:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
Clin Endocrinol (Oxf)
Año:
2015
Tipo del documento:
Article