Interleukin-6 in the Fever and Multiorgan Crisis of Pheochromocytoma

Abstract

A 31-y-old black man with neurofibromatosis, alcoholism and hypertension was admitted because of abdominal pain, hematemesis and cough. In the hospital he had prolonged fever and developed a multiorgan crisis. Despite thorough investigation, no infectious cause for fever was found. Urinary catecholamines and metabolites were markedly elevated. Computerized tomography revealed a mass abutting the left kidney. A diagnosis of pheochromocytoma was made, and as soon as treatment with phenoxybenzamine and propranolol was begun, the fever resolved. Serum interleukin-6 (IL-6) concentration was initially elevated, decreased after the start of adrenergic blockade, and gradually fell to an undetectable level after surgery. These observations suggest that interleukin-6 might have been causally related to the patient's fever and possibly the multiorgan crisis.

Systemic Inflammatory Syndrome and Hepatic Inflammatory Cell Infiltration Caused by an Interleukin-6 Producing Pheochromocytoma

“…Systemic inflammatory syndrome has been reported to be associated with IL-6 producing pheochromocytoma [5][6][7][8][9][10]. Patients with this condition invariably had fever, which responded well to non-steroidal antiinflammatory drugs (NSAID) and steroids.…”

“…To date, six cases of IL-6-producing pheochromocytoma have been described, all of which presented with fever and acute inflammatory symptoms [5][6][7][8][9][10]. We report here a case of IL-6 producing pheochromocytoma, which caused systemic inflammatory responses and hepatic inflammatory cell infiltration.…”

Systemic Inflammatory Syndrome Associated with a Case of Jugular Paraganglioma

“…IL-6 is a major inflammatory cytokine that modulates transcription to stimulate the synthesis of acute phase proteins, such as C-reactive protein, while inhibiting albumin synthesis (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). IL-6-producing tumors associated with paraneoplastic syndrome have been reported in 11 paraganglioma patients, including 10 with pheochromocytomas and 1 with a malignant paraganglioma (Table 2) (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Cases with IL-6-producing pheochromocytomas are characterized by the presence of pyrexia as well as systemic inflammatory syndrome.…”

“…Paragangliomas sometime secrete various neuropeptide hormones, such as adrenocorticotropic hormone, and inflammatory cytokines, such as interleukin-6 (IL-6). Systemic inflammatory syndrome, including pyrexia, is a rare presentation in patients with paraganglioma (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). We herein report the first known case of a jugular paraganglioma exhibiting systemic inflammatory syndrome.…”

Immune Modulation by Catecholamines - a Potential Mechanism of Cytokine Release in Heart Failure?

“…From these findings the question arises whether a causal relationship exists between adrenergic stress and the induction of IL-6. The classical catecholamine excess disease is pheochromocytoma, and a case report documented an elevated IL-6 level in this disease [14]. Catecholamine excess also characterizes chronic heart failure, elevated plasma norepinephrine concentrations being of higher prognostic value than commonly measured indexes of cardiac performance [4].…”