ACUTE HYPERTENSIVE CRISIS FOLLOWING OCTREOTIDE ADMINISTRATION IN A PATIENT WITH MALIGNANT PHEOCHROMOCYTOMA

A patient with a known history of resected pheochromocytoma was evalua ted for recurrent paroxysmal hypertension. The recurrent tumor was loc alized by magnetic resonance imaging and by somatostatin receptor scin tigraphy. Since this scintigraphy demonstrated the presence of somatos tatin receptors, empiric treatment with the somatostatin analogue octr eotide was initiated in an attempt to stabilize catecholamine secretio n prior to attempted surgical resection. The patient experienced a par adoxical reaction manifested by an acute hypertensive crisis which was rapidly responsive to intravenous nicardipine. Stimulation of such a hypertensive crisis by octreotide has not previously been reported. Th e etiology of this reaction is unclear. We conclude that octreotide an d other somatostatin analogues should be administered with extreme cau tion to patients with known or suspected pheochromocytomas.