Smita K. Baid, MD; Edwin W. Lai, BS; Robert A. Wesley, PhD; Alex Ling, MD; Henri J.L.M. Timmers, MD, PhD; Karen T. Adams, MSN, CRNP; Anna Kozupa, MD; Karel Pacak, MD, PhD, DSc
Baid SK, Lai EW, Wesley RA, Ling A, Timmers HJ, Adams KT, et al. Brief Communication: Radiographic Contrast Infusion and Catecholamine Release in Patients With Pheochromocytoma. Ann Intern Med. 2009;150:27-32. doi: 10.7326/0003-4819-150-1-200901060-00006
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Published: Ann Intern Med. 2009;150(1):27-32.
Contrast-enhanced computed tomography (CT) is useful for localizing pheochromocytoma. However, in patients with suspected pheochromocytoma, CT is often canceled or not performed because of the strong belief that intravenous contrast may induce hypertensive crisis.
To examine whether intravenous low-osmolar contrast administration during CT induces catecholamine release that increases blood pressure or heart rate.
Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland.
22 patients with pheochromocytoma (15 nonadrenal and 7 adrenal) and 8 unmatched control participants without pheochromocytoma.
Plasma catecholamine levels, blood pressure, and heart rate.
Plasma catecholamine levels within and between groups did not significantly differ before and after intravenous administration of low-osmolar CT contrast. Patients with pheochromocytoma experienced a clinically and statistically significant increase in diastolic blood pressure that was not accompanied by corresponding increases in plasma catecholamine levels. The difference became nonâ€“statistically significant after adjustment for use of Î±- and Î²-blockers.
The study lacked a placebo group, and the sample was relatively small.
Intravenous low-osmolar contrastâ€“enhanced CT can safely be used in patients with pheochromocytoma who are not receiving Î±- or Î²-blockers.
Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health.
Contrast media are widely thought to induce hypertensive crisis in patients with pheochromocytoma.
These researchers observed no instances of catecholamine surge or hypertensive crisis in a series of 22 patients with pheochromocytoma undergoing computed tomography with low-osmolar contrast.
The study had limited statistical power to detect differences between case patients and control participants.
Contemporary low-osmolar computed tomography contrast is safe for patients with pheochromocytoma.
CT = computed tomography.
* Initial enrollment period.
† Recommended to the authors to include more patients with solitary adrenal pheochromocytoma.
Arrows indicate the time of low-osmolar contrast injection. Bars represent 95% CIs. Number of patients with available data shown at each time point; there are no obvious outliers within the data.
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