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ARTICLE |

Surreptitious Self-administration of Epinephrine Resulting in 'Pheochromocytoma' FREE

Harry R. Keiser, MD
[+] Author Affiliations

Reprint requests to National Heart, Lung, and Blood Institute, Bldg 10, Room 8C-103, National Institutes of Health, Bethesda, MD 20892(Dr Keiser).


JAMA. 1991;266(11):1553-1555. doi:10.1001/jama.1991.03470110099040
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SELECTED CASE  A 35-YEAR-OLD woman with a possible pheochromocytoma was referred to the National Institutes of Health (NIH) from Pittsburgh, Pa. Her symptoms started in December 1987, when she developed headache, tremor, tachycardia, and mild hypertension after an injection of novocaine and epinephrine. Soon the episodes began to occur spontaneously. She often went to a local emergency department, where her blood pressure was as high as 160/100 mm Hg and her heart rate as high as 140 beats per minute. Her urinary epinephrine output was 1600 nmol/d (normal, <165 nmol/d). Her plasma norepinephrine (NE) level was 2.9 nmol/L (normal, <4.4 nmol/L) and plasma epinephrine, 2.8 nmol/L (normal, <0.55 nmol/L). In February 1988, a clonidine suppression test was performed. Basal plasma NE level was normal (1.4 nmol/L) and was suppressed normally to 0.49 nmol/L; basal plasma epinephrine level was markedly elevated (1.8 nmol/L), and was also suppressed into the normal range

REFERENCES

Bravo EL, Tarazi RC, Fouad FM, Vidt DG, Gifford RW Jr.  Clonidine-suppression test—a useful aid in the diagnosis of pheochromocytoma. N Engl J Med . 1989;;305:623-626.
Grossman E, Goldstein DS, Hoffman A, Keiser HR.  Glucagon and clonidine testing in the diagnosis of pheochromocytoma. Hypertension . 1991;;17:733-741.
Moll LV, McEwan AJ, Shapiro B, et al.  Iodine-131 MIBG scintigraphy of neuroendocrine tumors other than pheochromocytoma and neuroblastoma. J Nucl Med . 1987;;28:979-988.
Shapiro B, Copp JE, Sisson JC, Eyre PL, Wallis J, Beierwaltes WH.  Iodine-131 metaiodobenzylguanidine for the locating of suspected pheochromocytoma. J Nucl Med . 1985;;26:576-585.
O'Connor DT, Bernstein KN.  Radioimmunoassay of chromogranin A in plasma as a measure of exocytotic sympathetic sympathoadrenal activity in normal subjects and patients with pheochromocytoma. N Engl J Med . 1984;;311:764-770.
Lawrence AM.  Glucagon provocative test for pheochromocytoma. Ann Intern Med . 1967;;66:1091-1096.
American Psychiatric Association, Committee on Nomenclature and Statistics.Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987;.
Folks DG, Freeman AM.  Munchausen's syndrome and other factitious illnesses. Psychiatr Clin North Am . 1985;;8:263-278.
Kooiman CG.  Neglected phenomena in factitious illness. Compr Psychiatry . 1987;;28:499-507.
Aguilar-Parada E, Rivadeneyra J, Torres-Leon AG, Serrano PA.  Pseudopheochromocytoma. JAMA . 1971;;218:884-885.
Lurvey A, Yusin A, DeQuattro V.  Pseudopheochromocytoma after self-administered isoproterenol. J Clin Endocrinol Metab . 1973;;36:766-769.
Brandenburg RO, Gutnik LM, Nelson RL, Abboud CF, Edis AJ, Sheps SG.  Factitial epinephrine-only secreting pheochromocytoma. Ann Intern Med . 1979;;90:795-796.
Young MJ, Dmuchowski C, Wallis JW, Barnas GP, Shapiro B.  Biochemical tests for pheochromocytoma. J Gen Intern Med . 1989;;4:273-276.

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Bravo EL, Tarazi RC, Fouad FM, Vidt DG, Gifford RW Jr.  Clonidine-suppression test—a useful aid in the diagnosis of pheochromocytoma. N Engl J Med . 1989;;305:623-626.
Grossman E, Goldstein DS, Hoffman A, Keiser HR.  Glucagon and clonidine testing in the diagnosis of pheochromocytoma. Hypertension . 1991;;17:733-741.
Moll LV, McEwan AJ, Shapiro B, et al.  Iodine-131 MIBG scintigraphy of neuroendocrine tumors other than pheochromocytoma and neuroblastoma. J Nucl Med . 1987;;28:979-988.
Shapiro B, Copp JE, Sisson JC, Eyre PL, Wallis J, Beierwaltes WH.  Iodine-131 metaiodobenzylguanidine for the locating of suspected pheochromocytoma. J Nucl Med . 1985;;26:576-585.
O'Connor DT, Bernstein KN.  Radioimmunoassay of chromogranin A in plasma as a measure of exocytotic sympathetic sympathoadrenal activity in normal subjects and patients with pheochromocytoma. N Engl J Med . 1984;;311:764-770.
Lawrence AM.  Glucagon provocative test for pheochromocytoma. Ann Intern Med . 1967;;66:1091-1096.
American Psychiatric Association, Committee on Nomenclature and Statistics.Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987;.
Folks DG, Freeman AM.  Munchausen's syndrome and other factitious illnesses. Psychiatr Clin North Am . 1985;;8:263-278.
Kooiman CG.  Neglected phenomena in factitious illness. Compr Psychiatry . 1987;;28:499-507.
Aguilar-Parada E, Rivadeneyra J, Torres-Leon AG, Serrano PA.  Pseudopheochromocytoma. JAMA . 1971;;218:884-885.
Lurvey A, Yusin A, DeQuattro V.  Pseudopheochromocytoma after self-administered isoproterenol. J Clin Endocrinol Metab . 1973;;36:766-769.
Brandenburg RO, Gutnik LM, Nelson RL, Abboud CF, Edis AJ, Sheps SG.  Factitial epinephrine-only secreting pheochromocytoma. Ann Intern Med . 1979;;90:795-796.
Young MJ, Dmuchowski C, Wallis JW, Barnas GP, Shapiro B.  Biochemical tests for pheochromocytoma. J Gen Intern Med . 1989;;4:273-276.
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