title: Steroid-induced crisis and rhabdomyolysis in a patient with pheochromocytoma: a case report and review.
abstract: A 66-year-old Japanese woman was urgently referred to our hospital. Two days prior to admission, her general practitioner began to administer prednisolone for treatment of a diagnosis of polymyalgia rheumatica. At the time of admission, laboratory results indicated multiorgan failure with rhabdomyolysis. Abdominal ultrasonography and computed tomography revealed a tumor in the right adrenal gland. On the same day, we measured serum and urine cathecholamines, which were markedly elevated. Additionally, magnetic resonance imaging revealed an adrenal mass and metaiodobenzylguanidine scintigraphy showed labeling of the tumor. Then, the patient underwent surgical resection of the tumor via laparoscopy. Histological examination confirmed the diagnosis of pheochromocytoma. One week after the operation, serum and urinary catecholamine levels returned to normal. The patient was discharged 10 days after the operation, and has remained stable at home. This report indicates that steroid should be avoided if possible in patients with pheochromocytoma. Furthermore, pheochromocytoma should be recalled as a differential diagnosis whenever patients take a sudden turn for the worse, or have acute uncontrollable hypertension following steroid administration and/or whenever patients present with unexplained rhabdomyolysis.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takahashi
authors.forename: Toshio
authors.initials: T
authors.lastname: Shimada
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Tanabe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Yo
authors.initials: Y
authors.lastname: Murakami
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ishibashi
authors.forename: Reiko
authors.initials: R
authors.lastname: Kikkawa
authors.forename: Seiji
authors.initials: S
authors.lastname: Yano
authors.forename: Asuka
authors.initials: A
authors.lastname: Araki
authors.forename: Akira
authors.initials: A
authors.lastname: Inoue
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000175:diagnosis; D000368:Aged; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D009102:Multiple Organ Failure / Q000139:chemically induced / Q000175:diagnosis; D010673:Pheochromocytoma / Q000150:complications* / Q000175:diagnosis; D011111:Polymyalgia Rheumatica / Q000188:drug therapy*; D011239:Prednisolone / Q000009:adverse effects*; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone