Abstract
The aim of the study was to evaluate the effects of steroid administration under standardised
conditions in a range of patients both normal and with adrenal pathologies and to
review the impact on plasma catecholamines and metanephrines. Corticosteroid administration
has been linked to the development of hypertensive crises in patients with phaeochromocytoma,
however a mechanism for this is not fully understood. We aimed to add useful information
about the effect of steroids on levels of these hormones under usual circumstances.
A prospective, observational cohort study of 50 patients undergoing the low-dose dexamethasone
suppression test (LDDST) was undertaken. Additional blood samples were taken at the
start and end of the standard LDDST. Biochemical analysis was carried out for plasma
catecholamines and plasma free metanephrines. Demographic and hormonal data were acquired
from review of the notes or measured at baseline. No significant changes in plasma
catecholamines or metanephrines were seen at the end of the LDDST compared to baseline.
This was also true of subgroup analysis, divided by age, gender, or type of underlying
pathology. Our results suggest that hypertensive reaction responses, rare as they
are, are unlikely to be related to normal adrenal physiology. Thus LDDST is likely
to be safe under most circumstances, however caution should be exercised in patients
with adrenal masses with imaging characteristics compatible with phaeochromocytoma.
It may be prudent to defer glucocorticoid administration until functioning phaeochromocytoma
has been excluded biochemically.
Key words
steroid - hydrocortisone - phaeochromocytoma - adrenals - catecholamines - metanephrines
References
Correspondence
m.r.druce@qmul.ac.uk
