title: Glucagon-induced pheochromocytoma crisis.
abstract: OBJECTIVE
  To describe a previously asymptomatic woman who developed a glucagon-induced pheochromocytoma crisis during preparation for screening colonoscopy.
  
  
  METHODS
  We present the patient's clinical features, laboratory and imaging findings, and outcome and review the related literature.
  
  
  RESULTS
  A 76-year-old woman received glucagon to inhibit intestinal motility before routine colonoscopy. She immediately developed severe hypertension, cardiac arrhythmia, and altered mental status. Her hospital course was complicated by encephalopathy and cardiac, respiratory, renal, and hepatic failure. Computed tomography of the abdomen showed a 6.5 × 4.8-cm mass in the left adrenal gland. Biochemical testing for pheochromocytoma revealed markedly elevated plasma catecholamines and metanephrines and urinary vanillylmandelic acid and metanephrine. She underwent a successful laparoscopic left adrenalectomy. Findings from histopathologic and immunohistochemical examination of the adrenal mass were diagnostic of pheochromocytoma.
  
  
  CONCLUSIONS
  Glucagon administration induced catecholamine release from an occult pheochromocytoma, which caused multiorgan injury. Health care providers using glucagon must consider this rare, but life-threatening, complication.
authors.affiliation: Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA. ali.hosseinnezhad@stvincenthospital.com
authors.forename: Alireza
authors.initials: A
authors.lastname: Hosseinnezhad
authors.forename: Robert M
authors.initials: RM
authors.lastname: Black
authors.forename: Narothama Reddy
authors.initials: NR
authors.lastname: Aeddula
authors.forename: Deep
authors.initials: D
authors.lastname: Adhikari
authors.forename: Nitin
authors.initials: N
authors.lastname: Trivedi
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000139:chemically induced* / Q000175:diagnosis; D000368:Aged; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects; D005769:Gastrointestinal Motility / Q000187:drug effects; D005934:Glucagon / Q000009:adverse effects*; D006801:Humans; D010673:Pheochromocytoma / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D005765:Gastrointestinal Agents; D005934:Glucagon