Brief Communication: Radiographic Contrast Infusion and Catecholamine Release in Patients With Pheochromocytoma

6 January 2009 | Volume 150 Issue 1 | Pages 27-32

Background: 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.

Objective: To examine whether intravenous low-osmolar contrast administration during CT induces catecholamine release that increases blood pressure or heart rate.

Design: Prospective study.

Setting: Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland.

Participants: 22 patients with pheochromocytoma (15 nonadrenal and 7 adrenal) and 8 unmatched control participants without pheochromocytoma.

Measurements: Plasma catecholamine levels, blood pressure, and heart rate.

Results: 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 non–statistically significant after adjustment for use of - and β-blockers.

Limitation: The study lacked a placebo group, and the sample was relatively small.

Conclusion: Intravenous low-osmolar contrast–enhanced CT can safely be used in patients with pheochromocytoma who are not receiving - or β-blockers.

Funding: Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health.

Editors' Notes Context Contrast media are widely thought to induce hypertensive crisis in patients with pheochromocytoma. Contribution 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. Caution The study had limited statistical power to detect differences between case patients and control participants. Implication Contemporary low-osmolar computed tomography contrast is safe for patients with pheochromocytoma. —The Editors

 

Author and Article Information

From Eunice Kennedy Shriver National Institute of Child Health and Human Development and Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland, and Radboud University, Nijmegen Medical Center, Nijmegen, the Netherlands.

Acknowledgment: The authors thank Dr. Graeme Eisenhofer for his contribution in the preparation of this manuscript and the Warren G. Magnuson Clinical Center Department of Diagnostic Radiology staff for supporting the study.

Grant Support: By Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health.

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement: Study protocol: Précis available at http://pqs.cc.nih.gov/protocol_query/protocol/1442. The complete protocol is available from Dr. Pacak (e-mail, karel{at}mail.nih.gov). Statistical code: Available from Dr. Wesley (e-mail, bwesley{at}mail.nih.gov). Data set: Available from Dr. Pacak (e-mail, karel{at}mail.nih.gov).

Corresponding Author: Karel Pacak, MD, PhD, DSc, Reproductive and Adult Endocrinology Program, Section on Medical Neuroendocrinology, National Institutes of Health, Building 10, CRC, Room 1E-1-3140, 10 Center Drive, MSC-1109, Bethesda, MD 20892-1109; e-mail, karel{at}mail.nih.gov.

Current Author Addresses: Drs. Baid and Pacak and Ms. Adams: Eunice Kennedy Shriver National Institute of Child Health and Development, 10 Center Drive, CRC 1E-1-3140, MSC-1109, Bethesda, MD 20892.

Mr. Lai and Drs. Timmers and Kozupa: National Institutes of Health, 10 Center Drive, Bethesda, MD 20892.

Dr. Wesley: National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892.

Dr. Ling: National Institutes of Health, 9000 Rockville Pike, Room 1C-351x, Bethesda, MD 20892-1182.

Author Contributions: Conception and design: S.K. Baid, E.W. Lai, A. Ling, K. Pacak.

Analysis and interpretation of the data: S.K. Baid, E.W. Lai, R.A. Wesley, H.J.L.M. Timmers, K. Pacak.

Drafting of the article: S.K. Baid, E.W. Lai, H.J.L.M. Timmers, K. Pacak.

Critical revision of the article for important intellectual content: S.K. Baid, E.W. Lai, R.A. Wesley, A. Ling, H.J.L.M. Timmers, K. Pacak.

Final approval of the article: S.K. Baid, E.W. Lai, R.A. Wesley, K.T. Adams, H.J.L.M. Timmers, K. Pacak.

Provision of study materials or patients: S.K. Baid, A. Kozupa, K. Pacak.

Statistical expertise: R.A. Wesley.

Obtaining of funding: K. Pacak.

Administrative, technical, or logistic support: E.W. Lai, K.T. Adams, H.J.L.M. Timmers, K. Pacak.

Collection and assembly of data: S.K. Baid, E.W. Lai, H.J.L.M. Timmers, K. Pacak.