ECE2017 Eposter Presentations: Adrenal and Neuroendocrine Tumours Adrenal medulla (21 abstracts)
Ephedrine/caffeine toxicity masquerading as phaeochromocytoma in a vigorexic male with paroxysmal hypertension and headache
Manuel Nivelo-Rivadeneira 1 , Agnieszka Kuzior 1 , Sara Quintana-Arroyo 1 , Carmen Acosta-Calero 1 , Claudia Arnas-Leon 1 , Ana Delia Santana-Suarez 1 , Alba Lucia Tocino-Hernandez 3 & Francisco Javier Martinez-Martin 2
1Endocrinology Dpartment, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain; 2Outpatient Hypertension Clinic, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain; 3Primary Care Center, Arucas, Las Palmas de Gran Canaria, Spain.
Clinical case: A 19-year-old male came to the Emergency Department complaining about a holocraneal nonpulsatile headache growing in intensity for the last 3 h, unresponsive to common analgesics. He had been suffering anxiety sleep deprivation, nervousness, tremor and heart palpitations for the last week. Family history was irrelevant, and the patient had no history of hypertension, dyslipidaemia, diabetes or smoking or medication use; he reported moderate alcohol, coffee and energy drink consumption but no cocaine nor amphetamines. He was on a high-protein diet with casein-based supplements, maintained a very high level of physical exercise and lately had been consuming a ‘fat-burner’ obtained from a local gym, but ignored its composition. The patient was fully conscious and did not have chest pain, fever or dyspnoea. His BP was 219/126 mmHg and HR 129 bpm, with sinus tachycardia in the EKG. He was treated with diazepam and diltiazem, discharged with BP 154/87 and HR 98 and referred to our Endocrinology Clinic for phaeochromocytoma screening. He brought the ‘fat-burner’ pills containing ephedrine 50, ASA 100 and caffeine 150 mg; he had been taking 1–2 daily during the week before the hypertensive episode. He was asymptomatic, with athletic constitution, weight 87 kg, height 173 cm, BMI 29 kg/m2, waist 88 cm, impedanciometry 19% fat mass, BP 119/76, HR 75. Physical exam was otherwise unremarkable. Lab tests including metanephrines, aldosterone, PRA, TSH and microalbuminuria; chest X-ray and 24 h. ABPM were normal.
Diagnosis: Paroxysmal hypertensive episode caused by ephedrine/caffeine toxicity, with no target-organ damage. Vigorexia. Phaeochromocytoma/paraganglioma were ruled out.
Commentary: Ephedrine is a sympathomimetic amine with no legitimate medical indications at present, but widely used as doping or to trim subcutaneous fat. Its use has been linked with major cardiovascular and renal events, including ictus and sudden death, and must be discouraged.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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