Eisenhofer Graeme, Rivers Graham, Rosas Alejandro L, Quezado Zena, Manger William M, Pacak Karel
Department of Clinical Chemistry and Laboratory Medicine, University of Dresden, Dresden, Germany.
Drug Saf. 2007;30(11):1031-62. doi: 10.2165/00002018-200730110-00004.
The dangers of phaeochromocytomas are mainly due to the capability of these neuroendocrine tumours to secrete large quantities of vasoactive catecholamines, thereby increasing blood pressure and causing other related adverse events or complications. Phaeochromocytomas are often missed, sometimes only becoming apparent during therapeutic interventions that provoke release or interfere with the disposition of catecholamines produced by the tumours. Because phaeochromocytomas are rare, evidence contraindicating use of specific drugs is largely anecdotal or based on case reports. The heterogeneous nature of the tumours also makes adverse reactions highly variable among patients. Some drugs, such as dopamine D(2) receptor antagonists (e.g. metoclopramide, veralipride) and beta-adrenergic receptor antagonists (beta-blockers) clearly carry high potential for adverse reactions, while others such as tricyclic antidepressants seem more inconsistent in producing complications. Other drugs capable of causing adverse reactions include monoamine oxidase inhibitors, sympathomimetics (e.g. ephedrine) and certain peptide and corticosteroid hormones (e.g. corticotropin, glucagon and glucocorticoids). Risks associated with contraindicated medications are easily minimised by adoption of appropriate safeguards (e.g. adrenoceptor blockade). Without such precautions, the state of cardiovascular vulnerability makes some drugs and manipulations employed during surgical anaesthesia particularly dangerous. Problems arise most often when drugs or therapeutic procedures are employed in patients in whom the tumour is not suspected. In such cases, it is extremely important for the clinician to recognise the possibility of an underlying catecholamine-producing tumour and to take the most appropriate steps to manage and treat adverse events and clinical complications.
嗜铬细胞瘤的危险主要源于这些神经内分泌肿瘤分泌大量血管活性儿茶酚胺的能力，从而导致血压升高并引发其他相关不良事件或并发症。嗜铬细胞瘤常常被漏诊，有时仅在引发肿瘤儿茶酚胺释放或干扰其代谢的治疗干预过程中才会显现出来。由于嗜铬细胞瘤较为罕见，关于特定药物禁忌使用的证据大多来自轶事或病例报告。肿瘤的异质性也使得患者之间的不良反应差异很大。一些药物，如多巴胺D(2)受体拮抗剂（如甲氧氯普胺、维拉必利）和β肾上腺素能受体拮抗剂（β受体阻滞剂）显然具有很高的不良反应风险，而其他药物，如三环类抗抑郁药，在引发并发症方面似乎更不稳定。其他可能引起不良反应的药物包括单胺氧化酶抑制剂、拟交感神经药（如麻黄碱）以及某些肽类和皮质类固醇激素（如促肾上腺皮质激素、胰高血糖素和糖皮质激素）。通过采取适当的防护措施（如肾上腺素能受体阻滞），与禁忌药物相关的风险很容易降至最低。如果没有这些预防措施，心血管系统的脆弱状态会使手术麻醉期间使用的某些药物和操作变得特别危险。当在未怀疑患有肿瘤的患者中使用药物或治疗程序时，问题最常出现。在这种情况下，临床医生认识到潜在的儿茶酚胺分泌肿瘤的可能性并采取最适当的措施来处理和治疗不良事件及临床并发症极为重要。
