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
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.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
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
Download citation file:
Published: Ann Intern Med. 2009;150(1):27-32.
Adrenal Disorders, Endocrine and Metabolism, Endocrine Cancer, Hematology/Oncology.
Results provided by:
Copyright © 2018 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use