Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report
Abstract Background This report presents a case of cannabinoid-induced hyperemesis syndrome causing repeated violent retching in a patient with a large (8 cm) adrenal pheochromocytoma resulting in hypertensive urgency. Case presentation A 69-year-old white male patient with a previously diagnosed ph...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-024-04497-0 |
| _version_ | 1827310188417253376 |
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| author | Jeffrey M. Arendash Cornel Chiu Jocelyn Wang Fred Mihm |
| author_facet | Jeffrey M. Arendash Cornel Chiu Jocelyn Wang Fred Mihm |
| author_sort | Jeffrey M. Arendash |
| collection | DOAJ |
| description | Abstract Background This report presents a case of cannabinoid-induced hyperemesis syndrome causing repeated violent retching in a patient with a large (8 cm) adrenal pheochromocytoma resulting in hypertensive urgency. Case presentation A 69-year-old white male patient with a previously diagnosed pheochromocytoma presented to the emergency department with nausea and vomiting and was found to have hypertensive urgency. Computed tomography scan did not show any acute abdominal pathology and history was inconsistent with a gastrointestinal etiology. Patient had a history of daily cannabinoid use for many years and repeated self-limited hyperemesis episodes, and thus a diagnosis of cannabinoid-induced hyperemesis syndrome was made. It was concluded that the likely explanation for the hypertensive urgency was from physical compression of his adrenal tumor during the episodes of retching resulting in a catecholamine surge. The patient was given antiemetics and admitted to the intensive care unit for blood pressure management. Blood pressure was initially controlled with phentolamine and a clevidipine infusion, then transitioned to oral doxazosin and phenoxybenzamine. Hyperemesis and abdominal pain resolved after 24 hours, and his blood pressure returned to baseline. The patient was discharged with the recommendation to stop all cannabis use. On follow-up, his blood pressure remained well controlled, and he subsequently underwent adrenalectomy for tumor removal. Conclusion Hyperemesis can cause hypertensive events in patients with pheochromocytoma by increasing abdominal pressure, leading to catecholamine release. |
| first_indexed | 2024-04-24T19:55:39Z |
| format | Article |
| id | doaj.art-158e4fa1783443ae8f101814be7384a2 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-24T19:55:39Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-158e4fa1783443ae8f101814be7384a22024-03-24T12:21:41ZengBMCJournal of Medical Case Reports1752-19472024-03-011811510.1186/s13256-024-04497-0Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report Jeffrey M. Arendash0Cornel Chiu1Jocelyn Wang2Fred Mihm3Department of Anesthesiology, Stanford UniversityDepartment of Anesthesiology, Stanford UniversityDepartment of Anesthesiology, Stanford UniversityDepartment of Anesthesiology, Stanford UniversityAbstract Background This report presents a case of cannabinoid-induced hyperemesis syndrome causing repeated violent retching in a patient with a large (8 cm) adrenal pheochromocytoma resulting in hypertensive urgency. Case presentation A 69-year-old white male patient with a previously diagnosed pheochromocytoma presented to the emergency department with nausea and vomiting and was found to have hypertensive urgency. Computed tomography scan did not show any acute abdominal pathology and history was inconsistent with a gastrointestinal etiology. Patient had a history of daily cannabinoid use for many years and repeated self-limited hyperemesis episodes, and thus a diagnosis of cannabinoid-induced hyperemesis syndrome was made. It was concluded that the likely explanation for the hypertensive urgency was from physical compression of his adrenal tumor during the episodes of retching resulting in a catecholamine surge. The patient was given antiemetics and admitted to the intensive care unit for blood pressure management. Blood pressure was initially controlled with phentolamine and a clevidipine infusion, then transitioned to oral doxazosin and phenoxybenzamine. Hyperemesis and abdominal pain resolved after 24 hours, and his blood pressure returned to baseline. The patient was discharged with the recommendation to stop all cannabis use. On follow-up, his blood pressure remained well controlled, and he subsequently underwent adrenalectomy for tumor removal. Conclusion Hyperemesis can cause hypertensive events in patients with pheochromocytoma by increasing abdominal pressure, leading to catecholamine release.https://doi.org/10.1186/s13256-024-04497-0Cannabinoid hyperemesis syndromePheochromocytomaHypertensive urgency |
| spellingShingle | Jeffrey M. Arendash Cornel Chiu Jocelyn Wang Fred Mihm Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report Journal of Medical Case Reports Cannabinoid hyperemesis syndrome Pheochromocytoma Hypertensive urgency |
| title | Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report |
| title_full | Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report |
| title_fullStr | Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report |
| title_full_unstemmed | Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report |
| title_short | Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report |
| title_sort | cannabinoid hyperemesis and pheochromocytoma hypertensive urgency a case report |
| topic | Cannabinoid hyperemesis syndrome Pheochromocytoma Hypertensive urgency |
| url | https://doi.org/10.1186/s13256-024-04497-0 |
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