Adverse drug reactions in patients with phaeochromocytoma: Incidence, prevention and management

Graeme Eisenhofer, Graham Rivers, Alejandro L. Rosas, Zena Quezado, William M. Manger, Karel Pacak

Research output: Contribution to journalReview article

83 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1031-1062
Number of pages32
JournalDrug Safety
Volume30
Issue number11
DOIs
StatePublished - Jan 1 2007

Keywords

  • Adrenergic receptor antagonists, adverse reactions
  • Adverse drug reactions
  • Anaesthetics, adverse reactions
  • Antidepressants, adverse reactions
  • Beta adrenergic receptor antagonists, adverse reactions
  • Contrast media, adverse reactions

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Pharmacology
  • Toxicology
  • Health, Toxicology and Mutagenesis

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