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DOI:10.2214/AJR.06.5028
AJR 2006; 186:1201
© American Roentgen Ray Society

Extrarenal Pheochromocytoma

Ajit Singh Kashyap, Kuldip Parkash Anand and Surekha Kashyap

Department of Endocrinology Command Hospital (Southern Command) Pune, India
Department of Medicine Command Hospital (Eastern Command) Kolkata, India
Department of Hospital Administration Command Hospital (Southern Command) Pune, India

We read with interest the excellent case report regarding extraadrenal pheochromocytoma [1]. However, in spite of strong clinical suspicion of pheochromocytoma, after noticing hypertension and tachycardia following the needle biopsy, this patient was given metoprolol (a ß-adrenergic receptor blocker) alone to control his hypertension and tachycardia.

In pheochromocytoma, blockade of ß-adrenoceptors should never be initiated before blockade of {alpha}-adrenoceptors, since the loss of ß-adrenoceptors-mediated vasodilation, particularly in skeletal muscles, leaves {alpha}-adrenoceptor stimulation unopposed, which could result in a paradoxic increase in blood pressure and a hypertensive crisis [2, 3].


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  1. Dalal T Maher MM, Mueller PR. Extraadrenal pheochromocytoma: a rare cause of tachycardia and hypertension during percutaneous biopsy. AJR 2005; 185:554 -555[Free Full Text]
  2. Landsberg L, Young JB. Pheochromocytoma. In: Kasper DL, Braunwald E, Fauci AS, et al., eds. Harrison's principles of internal medicine, 16th ed., vol. II. New York: McGraw-Hill;2005: 2148-2152
  3. Lenders JWM, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet 2005; 366:665 -675[CrossRef][Medline]

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