Catecholamine Syndrome, Carcinoid Lung Tumor and Stroke

Catecholamine Syndrome, Carcinoid Lung Tumor and Stroke N. Nighoghossian, Service du Pr. P. Trouillas, Hôpital Neurologique, 59, boulevard Pinel, F-69394 Lyon (France) vealed a left lung lesion confirmed by thoracic CT scan; this tumor was peripherally located. A transbronchial biopsy ensured the diagnosis of an atypical carcinoid tumor. On electron microscopy, abundant dense-core granules were seen (fig. 1). A quantitative immunohistochemical analysis was performed both on neoplastic and healthy tissue; norepinephrine, adrenaline and dopamine levels reached 767 ug/g, 26.6 ug/g and 120(xg/g, respectively, in the neuroendocrine carcinoid tissue, whereas the norepiOn March 29, 1978 a 41-year-old man, without any risk factors for stroke, experienced a sudden gait disturbance accompanied by posterior headache. On examination, a heavy ataxia of stance, a left-side cerebellar ataxia of limb movements, a right hemiparesis sparing the face with bilateral Babinski’s sign, a left horizontal nystagmus and a marked dysarthria were noted. Sensory testing, alertness and memory were not impaired. His blood pressure was 175/ 75 mm Hg, pulse was regular, heart and neck auscultation and optic fundi appeared normal as did chest X ray, electrocardiogram and transthoracic echocardiography. On March 30, 1978 cerebral angiography performed by the Seldinger route was normal, and the head computed tomogram showed bilateral cerebellar infarcts. Three months later he complained of intermittent vasomotor disturbances such as palpitation, sweating or flushing, and as time went by his wife noticed paroxysmal behavioral changes. Anxiety, nervousness and depression were observed. In March 1988 he was in an insufferable state and was referred to our institution. Neurological examination was normal, his blood pressure was 180/100 mm Hg; a Holter recording showed continuous hypertension. Biological screening ruled out hyperthyroidism, Cushing’s syndrome or abnormal serotonin secretion. An increase of urinary catecholamine was discovered by the trihydroxyindole method: the norepinephrine level reached 2,394 nmol/24 h (normal value < 1,660 nmol/24 h). Chest X ray renephrine level in healthy parenchyma was only 37 u.g/g. Adrenalin and dopamine levels were not determined, abdominal computed tomography ruled out any tumor of the adrenal glands, bone scintigraphy was normal. Psychiatric and vasomotor symptoms cleared after surgery, and the patient’s blood pressure normalized. The urinary catecholamine level returned to a normal value. The long-term outcome was uneventful; 3 years later, there were no mood disturbances and his blood pressure was in the normal range.