Steroid-induced crisis and rhabdomyolysis in a patient with pheochromocytoma: a case report and review.

Abstract

A 66-year-old Japanese woman was urgently referred to our hospital. Two days prior to admission, her general practitioner began to administer prednisolone for treatment of a diagnosis of polymyalgia rheumatica. At the time of admission, laboratory results indicated multiorgan failure with rhabdomyolysis. Abdominal ultrasonography and computed tomography revealed a tumor in the right adrenal gland. On the same day, we measured serum and urine cathecholamines, which were markedly elevated. Additionally, magnetic resonance imaging revealed an adrenal mass and metaiodobenzylguanidine scintigraphy showed labeling of the tumor. Then, the patient underwent surgical resection of the tumor via laparoscopy. Histological examination confirmed the diagnosis of pheochromocytoma. One week after the operation, serum and urinary catecholamine levels returned to normal. The patient was discharged 10 days after the operation, and has remained stable at home. This report indicates that steroid should be avoided if possible in patients with pheochromocytoma. Furthermore, pheochromocytoma should be recalled as a differential diagnosis whenever patients take a sudden turn for the worse, or have acute uncontrollable hypertension following steroid administration and/or whenever patients present with unexplained rhabdomyolysis.

• Authors: Nobuyuki Takahashi, Toshio Shimada, Kazuaki Tanabe, Hiroyuki Yoshitomi, Yo Murakami, Yutaka Ishibashi, Reiko Kikkawa, Seiji Yano, Asuka Araki, Akira Inoue
• Journal: International journal of cardiology (Int J Cardiol) Vol. 146 Issue 2 Pg. e41-5 (Jan 21 2011) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 19187985 (Publication Type: Case Reports, Letter, Review)
• Copyright: Copyright © 2008. Published by Elsevier Ireland Ltd.

Chemical References

• Glucocorticoids
• Prednisolone

Topics

• Adrenal Gland Neoplasms (complications, diagnosis)
• Aged
• Female
• Glucocorticoids (adverse effects)
• Humans
• Multiple Organ Failure (chemically induced, diagnosis)
• Pheochromocytoma (complications, diagnosis)
• Polymyalgia Rheumatica (drug therapy)
• Prednisolone (adverse effects)
• Rhabdomyolysis (chemically induced, diagnosis)