Serotonin Reuptake Inhibitor Unmasks a Pheochromocytoma

Marc A.J. Seelen; Paul H.E.M. de Meijer; A. Edo Meinders

doi:10.7326/0003-4819-126-4-199702150-00021

Letters |15 February 1997

Serotonin Reuptake Inhibitor Unmasks a Pheochromocytoma

Marc A.J. Seelen, MD; Paul H.E.M. de Meijer, MD, PhD; A. Edo Meinders, MD, PhD

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TO THE EDITOR:

We describe a 55-year-old man with attacks of headache, nausea, palpitations, and perspiration after the dose of paroxetine (a serotonin reuptake inhibitor prescribed for depression) was doubled to 40 mg/d. His other medications were atenolol and a benzodiazepine. Physical examination showed that the patient was agitated and had striking peripheral vasoconstriction. Blood pressure varied between 240/130 and 80/40 mm Hg; the patient did not have orthostatic hypotension. Because of the patient's paroxysmal symptoms and striking changes in blood pressure, a pheochromocytoma was suspected. A 24-hour urinalysis showed noradrenalin, 9.2 nmol (normal, 0.06 to 0.47 nmol); adrenalin, 27 nmol (normal, <0.16 nmol); and vannillylmandelic acid, 147 mmol (normal, <30 mmol). A tentative diagnosis of pheochromocytoma was made. Computed tomography of the abdomen showed a mass of approximately 4 cm in diameter in the left adrenal gland. Results of pathologic examination after left-sided adrenalectomy were compatible with pheochromocytoma. After surgery, the patient had no symptoms and was normotensive.

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Letters |15 February 1997

Serotonin Reuptake Inhibitor Unmasks a Pheochromocytoma

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