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Phaeochromocytoma unearthed by fluoxetine
1Department of Medicine, Armed Forces Medical College, Pune, India.
Postgraduate Medical Journal
|April 25, 2000
Summary
High-dose selective serotonin reuptake inhibitors can cause hypertensive paroxysms by inhibiting noradrenaline reuptake. This can reveal an undiagnosed phaeochromocytoma, as seen with fluoxetine in this case.
Area of Science:
- Pharmacology
- Endocrinology
- Cardiology
Background:
- Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants.
- High doses of some SSRIs can exhibit non-specific noradrenaline reuptake inhibition.
- Phaeochromocytoma is a rare tumor of the adrenal medulla that secretes catecholamines.
Observation:
- A hypertensive paroxysm, a sudden and severe increase in blood pressure, can occur.
- This paroxysm may be triggered by the combined effects of SSRI non-specific noradrenaline reuptake inhibition and catecholamine release from phaeochromocytoma.
- Such an event can unmask a previously undiagnosed, clinically silent phaeochromocytoma.
Findings:
- A case report details the first instance of fluoxetine unmasking a phaeochromocytoma.
- Previous reports have documented paroxetine inducing hypertensive paroxysms that led to phaeochromocytoma detection.
- This highlights a potential risk associated with high-dose SSRI use in individuals with underlying phaeochromocytoma.
Implications:
- Clinicians should be aware of the potential for hypertensive paroxysms with high-dose SSRIs.
- Consideration of phaeochromocytoma may be warranted in patients experiencing unexplained hypertensive crises during SSRI therapy.
- This underscores the importance of careful patient selection and monitoring when prescribing SSRIs, particularly at higher doses.