Exp Clin Endocrinol Diabetes 2014; 122 - P130
DOI: 10.1055/s-0034-1372147

Risks of catecholaminergic crisis following steroid administration in patients with an adrenal mass: a literature review

C Barrett 1, S van Uum 1, JW Lenders 2, 3
  • 1Schulich School of Medicine and Dentistry, Western University, Department Internal Medicine, London, Canada
  • 2University Hospital Carl Gustav Carus, Technical University Dresden, Dept of Medicine MK III, Dresden, Germany
  • 3Radboud University Medical Centre, Dept. Internal Medicine, Nijmegen, Netherlands

Background: Administration of corticosteroids as diagnostic or therapeutic agents has been reported to carry an increased risk of a catecholaminergic crisis (CC) in patients harbouring a pheochromocytoma (PH).

Objective: To assess the characteristics of patients with catecholamine-producing tumors that were reported to have suffered from CC or death after administration of a steroid.

Methods: Pubmed was searched using combinations of the following search terms: PH, paraganglioma, adrenal incidentaloma, dexamethasone suppression test (DST), glucocorticoid, and hypertensive crisis.

From all 18 published cases (1969 – 2013), we retrieved information on medical history, presenting symptoms, dose and route of steroid administration, location and size of adrenal mass, biochemical phenotype and outcome.

Results: Four of these 18 patients died. In the 10 patients in whom tumor size was provided, the size was over 2 cm. Tumor location: right adrenal n = 10, left n = 5; Para-aortic n = 1; unknown n = 2.

Incidentalomas: Three patients with an incidentaloma experienced a CC after a high dose DST (fatal in one patient). Adrenal diameter was > 4 cm in all and density was > 28 HU in two. In two patients urinary tests of total metanephrines or VMA were falsely normal and one of them died. In the other patient the high dose DST was done despite elevated total metanephrines. There are no reports of a CC in incidentaloma patients undergoing a low dose DST (1 mg).

Steroid treatment: In 15 patients, therapeutic steroid doses were administered orally or parenterally for various indications such as auto-immune disease. Three patients died. In 5 out of the 15 patients, there were preexistent symptoms compatible with PH.

Conclusions: In patients with a large adrenal incidentaloma (> 4 cm), testing for PH should be carried out before doing a high dose DST. There is no evidence however that biochemical screening for PH is necessary prior to a low dose DST in patients with an incidentaloma.