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Editor's Correspondence |

Hyperresponsiveness of Arginine Vasopressin to Metoclopramide in Patients With Pheochromocytoma

Paolo Chiodera, MD; Riccardo Volpi, MD; Vittorio Coiro, MD
Arch Intern Med. 1999;159(21):-. doi:.
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The administration of metoclopramide hydrochloride is commonly used as a provocative test in the screening of patients with pheochromocytoma because it produces a severe pressor reaction in these patients.1 This phenomenon has been attributed to catecholamine-releasing effects of the antidopaminergic agent.1 However, a dissociation between blood pressure (BP) and plasma catecholamines has occurred in patients with pheochromocytoma,2 suggesting that other endocrine factors may play a role in the control of BP in these patients. Specifically, the pressor response during stimulation with metoclopramide might be mediated at least in part by enhanced circulating levels of vasopressin; the stimulatory effect of metoclopramide on vasopressin secretion is well known.3 To verify this possibility, we have evaluated the arginine vasopressin (AVP) secretory pattern in 3 patients affected by pheochromocytoma during stimulation with metoclopramide.

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Arginine vasopressin response to metoclopramide hydrochloride in 3 patients with pheochromocytoma before (left) and after (right) adrenalectomy. The shaded area between the dotted lines (left) represents the normal range of arginine vasopressin responses to metoclopramide hydrochloride (10 mg intravenously) found in our laboratory in a wide population of healthy subjects.

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