Reactions 674 - 25 Oct 1997

★ SClomipramine

First report of phaeochromocytoma crisis: casereport

Phaeochromocytoma crisis occurred in a 53-year-old manduring treatment with clomipramine.

The man, who had bipolar psychosis, had been treated withlithium for 12 years and perphenazine for 1 year, when hestarted treatment with clomipramine 25 mg/day for worseningdepression. Three weeks later, he was hospitalised with a2-week history of profound weakness and a 2-day history ofsevere headache, blurred vision and fever.

On admission, the man was confused. His BP was200/120mm Hg and an ECG showed sinus tachycardia. Hiscondition deteriorated within a few hours and he developedhypoxaemia, requiring artificial ventilation. He was treatedwith IV labetalol, aciclovir and dantrolene. However, thehypertension persisted over the next 3 days.

A catecholamine-producing tumour was suspected and anabdominal CT scan showed a left solid suprarenal mass. Theman’s total plasma norepinephrine [noradrenaline] andepinephrine [adrenaline] levels were 23 000 pg/ml (normal100–410) and 13 000 pg/ml (≤ 45), respectively. He startedtreatment with phenoxybenzamine. After 2 weeks, the masswas resected and histological analysis showed a typicalphaeochromocytoma. After a further 2 weeks, the man wasdischarged with a regimen of lithium only.

Author comment: ‘This patient presented here is the first inwhom clomipramine is associated with a life-threateningpheochromocytoma crisis.’Korzets A, et al. Clomipramine-induced pheochromocytoma crisis: a near-fatalcomplication of a tricyclic antidepressant. Journal of Clinical Psychopharmacology17: 428-430, Oct 1997 - Israel 800619631

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Reactions 25 Oct 1997 No. 6740114-9954/10/0674-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved