A 78-year-old male with Rasagiline-Induced Pseudopheochromocytoma: The first Case Report from Syria

Abstract

Background: Pseudopheochromocytoma is a clinical disorder characterized by severe paroxysmal vasoconstriction and normal or mildly to moderately elevated levels of catecholamines and metanephrine, without any evidence of a tumorous origin. Because the adrenergic system is activated, the patients have severe paroxysmal hypertension along with headache, palpitations, and diaphoresis. Rasagiline-induced pseudopheochromocytoma is very rare. Our case report is the first one worldwide manifesting with this medication. Case presentation: The patient, a 78-year-old man with Parkinson's disease, started exhibiting symptoms of paroxysmal high blood pressure that did not decrease despite taking antihypertensive medications. An endocrine evaluation confirmed significantly elevated levels of urine dopamine and homovanillic acid, as well as plasma dopamine, with high levels of urine normetanephrine. Fludeoxyglucose scintigraphy ruled out the presence of a pheochromocytoma localized in the adrenals, migratory, or metastatic. A PET scan revealed no abnormalities. The Rasagiline treatment was stopped for eight days and was replaced with 200mg of amantadine every day. Two weeks after the discontinuation, we noticed a normalization of the elevated urinary and plasma dopamine levels as well as the increased urinary homovanil. Conclusions: Pseudopheochromocytoma may be related to Rasagiline alone or in conjunction with other drugs that have a tendency to inhibit catecholamine or dopamine metabolism.