SAT-495 From Comfort to Catastrophe: Steroid-induced Pheochromocytoma Crisis in a Neurofibromatosis Type 1 Patient After Spine Surgery

Abstract Disclosure: M. Viana Padilha: None. M. Barnett: None. E. Messina: None. J. Carty: None. S. Ram Teja Sathi: None. S. Wajnsztajn: None. N. Shah: None. C. Anastasopoulou: None. J.V. Mayrin: None. Z. Azmaiparashvili: None. Introduction: Pheochromocytoma occurs in 0.1-5.7% of individuals with neurofibromatosis type 1. Although pheochromocytoma crisis is rare, it can cause severe hemodynamic instability and may be triggered by various factors. We present a case of steroid-induced pheochromocytoma crisis, an uncommon complication in clinical practice. Case Presentation: A 33-year-old female with neurofibromatosis type 1 was admitted for an elective laminectomy of the cervical vertebra and resection of a spinal neurofibroma. The procedure occurred without complications. On the fifth post-operative day, the patient developed worsening pain and weakness in the left upper extremity. Magnetic resonance imagining showed cervical cord edema extending from the third to seventh cervical vertebra. She was initiated on intravenous Dexamethasone, 6mg every 6 hours. On the sixth post-operative day, the patient was found to be tachycardic with heart rate of 188 beats per minute, with systolic blood pressure ranging from 180-200 mmHg. Upon review of patient's previous charts, she was found to have a known adrenal incidentaloma and increased metanephrines levels in the past that had been missed in the pre-operative workup. Laboratory analysis of the current event revelead free metanephrines levels of 8618 pg/ml (normal < 57 pg/ml) and normetanephrine levels of 3541 pg/ml (normal < 148 pg/ml), with urine metanephrines also elevated. Endocrinology was consulted and patient was managed for steroid-induced pheochromocytoma crisis. Steroids were discontinued. Two months later, she underwent adrenalectomy and pathological analysis confirmed the diagnosis of pheochromocytoma. Discussion Pheochromocytoma crisis can be precipitated by several factors, including surgical procedures, anesthesia, and medications. While these factors are well-documented, the role of steroids in precipitating pheochromocytoma crisis is less recognized, with only approximately twenty cases reported. Steroids are thought to trigger a crisis through interesting biochemical pathways. They increase the production of catecholamines by stimulating the activities of key enzymes in their biosynthetic pathway and enhance their effects on the peripheral vasculature, resulting in a hypertensive crisis. So, they can exacerbate the effects of the already elevated levels of catecholamines and lead to life-threatening complications. In this case, the patient did not develop a pheochromocytoma crisis immediately following surgery, despite a lack of standard preparations, such as preoperative alpha-blockage. However, after corticosteroid administration, the crisis developed. This suggests that the steroids precipitated the event. While this is not commonly reported, this case highlights the importance of cautious steroid use in patients with a known diagnosis of pheochromocytoma or in those with a high suspicion of the condition. Presentation: Saturday, July 12, 2025