Influence of opioid antagonism on plasma catecholamines in pheochromocytoma patients

The present study investigated whether in vivo endogenous opioids inhibit the secretory activity of pheochromocytomas and whether opioid antagonists may be useful in the diagnosis of pheochromocytoma. In six patients with pheochromocytoma in whom the diagnosis was histologically confirmed after surgery, mean intraarterial blood pressure (BP) increased by 45 mm Hg within 3 min after intravenous (i.v.) injection of 2 mg glucagon (95% confidence interval 23-68 mm Hg); heart rate (HR) remained unchanged, whereas plasma norepinephrine (NE) increased by 216% (31-658%) and plasma epinephrine (EPI) increased by 203% (37-571%). Although glucagon stimulation confirmed the secretory potential of the pheochromocytomas, opioid antagonism by a 10-mg i.v. bolus of naloxone produced no significant change in plasma NE and EPI concentrations or intraarterial pressure. The present study does not support the hypothesis that release of catecholamines from pheochromocytomas is inhibited by endogenous opioids. Use of opioid antagonists as a tool in the diagnosis of pheochromocytoma therefore cannot be recommended.