Metoclopramide

Abstract

basophilic cytoplasm arranged in an alveolar Zellballen pattern due to the vascular barrier. Thus, a diagnosis of S Metoclopramide pheochromocytoma was confirmed. Her Ki67 index was below 2%. Her pheochromocytoma of the adrenal gland Pheochromocytoma crisis: case report scaled score was 1 point, and grading system for adrenal A 38-year-old woman developed pheochromocytoma crisis pheochromocytoma and paraganglioma score was 0 point. following treatment with metoclopramide for nausea. Author comment: Pheochromocytoma crisis is induced The woman, who received IV metoclopramide 10mg by daily life triggers such as bending forward, sneezing, and [frequency not stated] for nausea developed sudden pregnancy, mechanical stimulation such as abdominal palpitations and headache while seated and studying. palpation, the administration of agents such as Additionally, she developed chest pain, and she consulted to a metoclopramide . local doctor. She then presented with hypertension (190/110mm Hg). Her abdominal CT revealed a 40mm right Koizumi G, et al. Continuous hemodiafiltration for pheochromocytoma crisis with adrenal gland tumour with a central low density area. As she a positive outcome. Internal Medicine 58: 3113-3119, No. 21, Jan 2019 Japan 803437895 was diagnosed with hypertensive crisis, she was transferred to emergency centre for further testing and treatment. Laboratory investigation revealed body temperature 36.1°C, consciousness level at Glasgow Coma Scale (GCS) E3V5M6, HR 118 beats/minutes (bpm), BP 167/117mm Hg, RR 22 breaths/minutes, peripheral capillary oxygen saturation (SpO2) 97%, hyperglycaemia, slightly elevated creatinine and elevated WBC count and cardiac enzyme level. During her physical examination, a coarse crackles were heard in both lung fields. A pitting oedema of the lower limbs as well as marked sweating of the entire body was noted. On day 4 of hospitalisation, she was found to have high levels of blood adrenalin, noradrenalin, urinary catecholamines and their metabolites. Her plain chest X-ray revealed a cardiothoracic ratio of 46%, and ground glass opacities in both lung fields. An ECG revealed poor R-wave progression in V2-4 and ST depression in V4-5. Her ejection fraction was around 40%, although no abnormalities in wall motion were noted by an emergent cardiac ultrasonography. Her pre-surgery abdominal contrast enhanced CT scan revealed a sharply marginated, 40mm tumour in the right adrenal gland with a central lowdensity area. Based on hyperglycaemia, hypertension, excessive sweating, tachycardia and the finding of a right adrenal gland tumour, she was diagnosed with pheochromocytoma [duration of treatment to reaction onset not stated]. She also diagnosed with acute heart failure as her SpO2 had reduced to 80%, worsening of oxygenation (partial pressure (pO2) 63.2mm Hg), pink frothy sputum and a worsening of coarse chest crackles. The woman was then received non-invasive positive pressure ventilation; however, her oxygenation did not improve. Additionally, her level of consciousness and BP were declined. One and a half hours post her hospitalisation, she went into cardiac arrest, and cardiopulmonary resuscitation and tracheal intubation were done. After receiving epinephrine [adrenalin], her spontaneous circulation return, but her BP elevated. In order to achieve an antihypertensive effect and rate control, she received landiolol and phentolamine were initiated. However, her BP was as high as 182/148mm Hg, with a HR 156 bpm. As her catecholamine levels were not known at the time, pheochromocytoma crisis was strongly suspected. In order to stabilise her condition, she received continuous hemodiafiltration (CHDF) for catecholamine removal was initiated 3.5 hours post phentolamine and landiolol infusion. Her vital signs stabilised rapidly with CHDF and pharmacological therapy, with well controlled systolic BP (110–140mm Hg) and diastolic BP (60–80mm Hg). However, on day 4 of hospitalisation, CHDF was stopped after a total of 71 hours due to incircuit coagulation. Her HR increased temporarily to around 120 bpm after CHDF was discontinued, but it dropped subsequently. By day 6, her blood catecholamine levels decreased, but it still remained significantly elevated. Although, no subsequent elevation was noted until the surgery. On day 13, she underwent laparoscopic right adrenal gland resection. On the next day, her blood, urinary catecholamine concentrations and urinary metabolites decreased to almost normal reference ranges. On day 48, she was discharged home after rehabilitation. On gross examination, congestion and haemorrhaging were observed in the centre of the cystic tumour. As per the pathological findings a proliferation of tumour cells with wide 1