Sympathoadrenomedullary hyperactivity in the neuroleptic malignant syndrome: a case report

Jh, Feibel; Rb, Schiffer

doi:10.1176/ajp.138.8.1115

Cited by 63 publications

(3 citation statements)

References 4 publications

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“…In our patient, 24-hour urinary catecholamine levels were markedly elevated, with norepinephrine excretion greater than 3.5 times the upper limit of normal (ULN), epinephrine excretion greater than 6.5 times ULN, and dopamine excretion greater than 2.3 times ULN. These results are in accordance with the increased urinary catecholamine and metanephrine values described in other case reports for both MC and NMS [25–27]. …”

Section: Discussionsupporting

confidence: 93%

Malignant Catatonia Mimicking Pheochromocytoma

Wong

Hughes²,

Pudek³

et al. 2013

Case Reports in Endocrinology

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Malignant catatonia is an unusual and highly fatal neuropsychiatric condition which can present with clinical and biochemical manifestations similar to those of pheochromocytoma. Differentiating between the two diseases is essential as management options greatly diverge. We describe a case of malignant catatonia in a 20-year-old male who presented with concurrent psychotic symptoms and autonomic instability, with markedly increased 24-hour urinary levels of norepinephrine at 1752 nmol/day (normal, 89–470 nmol/day), epinephrine at 1045 nmol/day (normal, <160 nmol/day), and dopamine at 7.9 μmol/day (normal, 0.4–3.3 μmol/day). The patient was treated with multiple sessions of electroconvulsive therapy, which led to complete clinical resolution. Repeat urine collections within weeks of this presenting event revealed normalization or near normalization of his catecholamine and metanephrine levels. Malignant catatonia should be considered in the differential diagnosis of the hypercatecholamine state, particularly in a patient who also exhibits concurrent catatonic features.

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Section: Discussionsupporting

confidence: 93%

Malignant Catatonia Mimicking Pheochromocytoma

Wong

Hughes²,

Pudek³

et al. 2013

Case Reports in Endocrinology

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“…The findings in the present study cannot entirely explain the pathophysiology of malignant catatonia, but do indicate that hyperactivity of the sympathetic nervous system may be an important factor. Further, it is interesting to consider that previous studies have reported increased urine and plasma catecholamine levels in neuroleptic malignant syndrome 17,18. Although the data are insufficient to conclude that neuroleptic malignant syndrome and malignant catatonia are variants of the same disorder, these two disorders may be highly similar in terms of sympathetic nervous system hyperactivity.…”

Section: Discussionmentioning

confidence: 97%

Increased biogenic catecholamine and metabolite levels in two patients with malignant catatonia

Nisijima

2013

NDT

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The pathophysiology of malignant catatonia, a rare life-threatening psychiatric syndrome, has not yet been elucidated. This paper reports on two patients with malignant catatonia who showed elevated urinary or plasma catecholamine levels. Patient 1 had high catecholamine and metabolite levels in a 24-hour urine sample, and patient 2 had elevated plasma catecholamine levels. These findings indicate the presence of peripheral sympathetic nervous system hyperactivity in malignant catatonia. Symptoms of autonomic dysfunction, including tachycardia, labile blood pressure, and diaphoresis, are typical features of malignant catatonia and may be related to the increased levels of biogenic amines in these cases. Although the findings in the present study cannot entirely explain the pathophysiology of malignant catatonia, they do indicate that hyperactivity of the sympathetic nervous system may be involved in the pathology of this condition.

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“…The decreased levels of homovanillic acid, a CSF metabolite of dopamine, also supports this theory 18 . Other hypotheses are that sympathoadrenal dysfunction has a contributory role in NMS 19 , or a low serum iron concentration can be a contributory factor in decreasing the number of dopaminergic receptors, thereby leaving patients susceptible to developing NMS. This is supported by the finding of low serum iron in patients with NMS 20 .…”

Section: Discussionmentioning

confidence: 99%

Case Report: Neuroleptic malignant syndrome in a HIV-positive patient

et al. 2021

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We report a 29-year-old, HIV-positive woman being treated with antipsychotic medication for psychosis (Clopixol 200mg intramuscularly monthly, Risperidone 2mg orally daily Haloperidol 2.5mg twice a day), who presented with neuroleptic malignant syndrome. She was also receiving lorazepam and sodium valproate. The patient was referred to our department as she had developed involuntary upper limb movements and simple permanent focal seizure on the lower part of the left hemiface. Clinically the patient had altered consciousness, autonomic dysfunction, and rigidity. Her blood tests showed elevated creatine kinase (1467U/L) but no leucocytosis. We did a thorough workup for other causes of such a presentation. A comprehensive history was taken from the family to exclude other medications used. Her cerebrospinal fluid results were average. Blood tests did not show evidence of infection or other abnormalities. Computed tomography brain was normal. The patient died a few days after the beginning of the attack, which we have also observed in other HIV-female patients. As far as we know, it is the first report about this comorbidity reported in the medical literature.

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Sympathoadrenomedullary hyperactivity in the neuroleptic malignant syndrome: a case report

Cited by 63 publications

References 4 publications

Malignant Catatonia Mimicking Pheochromocytoma

Malignant Catatonia Mimicking Pheochromocytoma

Increased biogenic catecholamine and metabolite levels in two patients with malignant catatonia

Case Report: Neuroleptic malignant syndrome in a HIV-positive patient

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