Risk of catecholaminergic crisis following glucocorticoid administration in patients with an adrenal mass: a literature review.
BACKGROUND
Glucocorticoids as diagnostic or therapeutic agents have been reported to carry an increased risk of catecholaminergic crisis (CC) in patients with pheochromocytoma or paraganglioma (PPGL).


METHODS
We searched literature databases using the following terms: pheochromocytoma, paraganglioma, adrenal incidentaloma, steroids, glucocorticoids, dexamethasone suppression test (DST), hypertensive crisis, cosyntropin and CRH. From all published case reports (1962-2013), we reviewed medical history, presenting symptoms, dose and route of steroid administration, location and size of adrenal mass, biochemical phenotype and outcome.


RESULTS
Twenty-five case reports describing a CC were identified. Three patients with an adrenal incidentaloma suffered a CC following high-dose DST, and in one case, this was fatal. In two of these patients, biochemical testing missed the diagnosis, and in the third, a DST was done despite elevated urinary metanephrines. No CC has been reported for patients undergoing a low-dose DST. Three of 16 patients who received therapeutic glucocorticoids and four of six patients following cosyntropin testing died. No specific biochemical phenotype was related to adverse events.


CONCLUSIONS
Although a causal relationship cannot be established from this review, it seems prudent to exclude a PPGL in patients with a large incidentaloma or when high-dose DST is considered in a patient with an incidentaloma of any size. Our literature review does not support the need for biochemical testing for PPGL prior to a low-dose (1 mg) DST. Finally, before starting therapeutic glucocorticoids, any clinical signs or symptoms of a potential PPGL should prompt reliable biochemical testing to rule out a PPGL.
Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Catherine
C
Barrett
Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Stan H M
SH
van Uum
Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Germany.|Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Jacques W M
JW
Lenders
D000310:Adrenal Gland Neoplasms / Q000150:complications*; D003366:Cosyntropin / Q000009:adverse effects; D003907:Dexamethasone / Q000009:adverse effects*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D010673:Pheochromocytoma / Q000150:complications*
D005938:Glucocorticoids; D003366:Cosyntropin; D003907:Dexamethasone