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Pheochromocytoma crisis precipitated by dexamethasone with profound lactic acidosis, but without severe hypertension.
Pheochromocytoma crisis precipitated by dexamethasone with profound lactic acidosis, but without severe hypertension. Endocrinology, diabetes & metabolism case reports Lin, D., Madhok, J., Bouhenguel, J., Mihm, F. 2022; 2022Abstract
Summary: We describe a case of a 47-year-old patient who presented with severe lactic acidosis, troponinemia, and acute kidney injury after receiving 8 mg of intramuscular dexamethasone for seasonal allergies in the setting of an undiagnosed epinephrine-secreting pheochromocytoma. This case was atypical, however, in that the patient exhibited only mildly elevated noninvasive measured blood pressures. Following a period of alpha-adrenergic blockade, the tumor was resected successfully. Steroid administration can precipitate pheochromocytoma crisis that may present unusually as in our patient with mild hypertension but profound lactic acidosis.Learning points: Steroids administered via any route can precipitate pheochromocytoma crisis, manifested by excessive catecholamine secretion and associated sequelae from vasoconstriction. Lack of moderate/severe hypertension on presentation detracts from consideration of pheochromocytoma as a diagnosis. Lactatemia after steroid administration should prompt work-up for pheochromocytoma, as it can be seen in epinephrine-secreting tumors. Noninvasive blood pressure measurements may be unreliable during pheochromocytoma crisis due to excessive peripheral vasoconstriction.
View details for DOI 10.1530/EDM-22-0306
View details for PubMedID 36511456