Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Endocrinology
Volume 2013 (2013), Article ID 194927, 3 pages
http://dx.doi.org/10.1155/2013/194927
Case Report

Clozapine Use Presenting with Pseudopheochromocytoma in a Schizophrenic Patient: A Case Report

1University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
2Waikato General Hospital, Hamilton 3240, New Zealand
3University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
4Walsall Healthcare NHS Trust, Walsall WS2 9PS, UK
5Diabetes and Endocrinology, Birmingham Heartlands Hospital, Heart of England Foundation Trust, Birmingham B9 5SS, UK
6College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK

Received 1 December 2012; Accepted 5 January 2013

Academic Editors: M. Demura, L. Meyer, and T. Nagase

Copyright © 2013 Jaskanwal Sara et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. There have been six previous cases that reported pseudopheochromocytoma in patients taking clozapine. Our case showed the direct link of clozapine to serum levels of certain markers. Case. This is a case of a 49-year-old obese Caucasian female who was referred to endocrinology for investigation of Cushing’s syndrome, based on raised blood pressure and Cushingoid facies. The patient had underlying schizophrenia and was stable on clozapine. Her blood pressure was 150/99 mmHg on bendroflumethiazide and candesartan. We measured her 24-hour urinary-free cortisol, which was normal but 24-hour urinary-free noradrenaline was elevated at 835 nmol (76–561) with normal adrenaline 36 nmol (7–82) and dopamine 2679 nmol (366–2879), as the patient had history of palpitations and sweating. Two sets of 24-hour urinary-free cortisol measurements were normal and serum cortisol suppressed to <50 nmol/l after a 1 mg overnight dexamethasone. Two further 24-hour urinary-free catecholamines showed a raised level of noradrenaline. MRI demonstrated normal adrenals and MIBG scan did not show any abnormal uptake at adrenal glands. Conclusion. Pseudopheochromocytoma has been reported in patients taking clozapine. A number of different mechanisms for raised plasma noradrenaline levels with clozapine have been postulated. The above case highlights an unusual but known side effect of clozapine.