Catecholamine Crisis Precipitated by Intra-Articular Glucocorticoid Administration in a Patient with Paraganglioma

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ABSTRACT Objective: Oral and parenteral glucocorticoids are associated with catecholamine crisis, but association with intra-articular steroid formulation has not been previously described. We aim to describe the onset of catecholamine crisis, induced by administration of intra-articular triamcinolone acetonide (TCA), in the setting of abdominal paraganglioma (PGL). Methods: We present a case with characteristic clinical and biochemical features of catecholamine crisis, propose mechanisms of glucocorticoid-induced catecholamine surge, and also discuss the pharmacokinetics of intra-articular TCA. Results: A 77-year-old physically active, asymptomatic male with history of well-controlled hypertension and remote coronary artery disease presented with abrupt onset of chest pain and oscillating hypotensive and hypertensive episodes. Cardiac catheterization was unrevealing for new ischemia. Abdominal imaging identified a 9 × 8 cm midabdominal left peri-aortic mass. Plasma and urine metanephrines were elevated m...