ECE2007 Poster Presentations (1) (659 abstracts)
Pseudophaeochrocytoma presenting with catatonia - a novel observation
Bahram Jafar-Mohammadi 1 , Thomas Walsh 2 , John Barry 1 , James Ryan 1 , Eleanor Mullan 3 , Eugene Cassidy 3 , Michael O’Connor 2 & Domhnall O’Halloran 1
1Dept. of Endocrinology,Cork University Hospital, Cork, Ireland; 2Dept.of Geriatric Medicine, Cork University Hospital, Cork, Ireland; 3Dept. of Psychiatry, Cork University Hospital, Cork, Ireland.
A 74 year old lady was admitted with an agitated depression. She had been taking Lorazepam and Olanzapine throughout the preceding 6 months. Escitalopram had been introduced 2 months prior to admission and the dose was escalated 3 weeks prior to presentation. The dose of Olanzapine was doubled at the same time.
She was treated with sotalol for atrial fibrillation and she had documented labile hypertension (BP range 77/57–250/118). She had fluctuating levels of consciousness and developed catatonia on day 20 of her admission. 24 hour urinary cathecholamines were reported as:
• Noradrenaline 4100 nmol/24hrs (160–485)
• Adrenaline 854 nmol/24hrs (27–165)
• Dopamine 5486 nmol/24hrs(1300–3000)
The patient was referred to our endocrine service on day 21 of admission. Olanzapine and Escitalopram were stopped and she was commenced on phenoxybenzamine (via NG Tube). Within 24hours her level of consciousness had returned to normal. Her alpha-blockade therapy was escalated until a postural drop in BP was achieved.
A CT body (contrasted), MIBG scan and MRI brain were normal.
The patient has remained clinically well, with no features suggestive of phaeochromocytoma 8 months after presentation. These observations and the normalisation of her urinary cathecholamines and negative radiological investigations support a diagnosis of pseudophaeochromocytoma secondary to either Olanzapine or Escitalopram. Catecholamine levels have remained normal in this patient while off antipsychotic and SSRI therapy. This we believe is the first presentation of pseudopheochromocytoma with catatonia as a dominant feature.
This case illustrates the need for vigilance in making a diagnosis of phaeochromocytoma in patients who are on drugs which alter neurotransmitter metabolism.
| Day of admission | 8 | 24 | 25 | 43 | 66 | Range |
| Volume | 1440 | 962 | 514 | 1745 | 2320 | mls |
| Noradrenaline | 4100 | 638 | 537 | 92 | 197 | 160–485 |
| Adrenaline | 854 | 176 | 101 | – | – | 1300–3000 |
| Dopamine | 5486 | 1100 | 1108 | 710 | 979 | 600–1300 |
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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