metyrosine / Generic mfg. - LARVOL DELTA

Preoperative Metyrosine Administration for Bilateral Pheochromocytomas Following Pheochromocytoma Crisis: A Case Report. (PubMed, IJU Case Rep) - "This case supports the feasibility of preoperative metyrosine administration in a high-risk patient. Although its effect on intraoperative hemodynamic stability remains uncertain, metyrosine may be considered as an adjunct to conventional α-adrenergic blockade in carefully selected patients."

Journal • Cardiomyopathy • Cardiovascular • Hypotension • Oncology • Solid Tumor

A Rare Case of Combined Pheochromocytoma and Primary Diffuse Large B-Cell Lymphoma within A Giant Adrenal Tumor (ENDO 2026) - "A CT-guided biopsy (scant, predominantly necrotic tissue) was interpreted as EBV-positive large B-cell lymphoma, and he underwent six cycles of R-CHOP, including high-dose prednisone (100 mg daily), without hypertensive crisis...Biochemical evaluation revealed markedly elevated plasma metanephrines 12.0 nmol/L (0–0.49), plasma normetanephrine >50 nmol/L (0–0.89), plasma norepinephrine 14,888 pmol/L (reference 1,050–4,800), epinephrine 1,674 pmol/L (≤330) and dopamine 622 pmol/L (≤240)...Preoperative preparation included alpha-adrenergic blockade with doxazosin, high salt and fluid intake, followed by beta-blockade, and metyrosine 4 days prior to surgery due to the large tumor size and marked biochemical activity... Our case highlights the diagnostic and management challenges posed by a rare combined pheochromocytoma and primary lymphoma in the same adrenal tumor. This case reinforces the need for comprehensive hormonal assessment of retroperitoneal masses to guide..."

Clinical • Adrenal Cortex Carcinoma • B Cell Lymphoma • Diffuse Large B Cell Lymphoma • Endocrine Cancer • Hematological Malignancies • Hypertension • Large B Cell Lymphoma • Lymphoma • Neuroendocrine Neoplasm • Non-Hodgkin’s Lymphoma • Oncology • Solid Tumor • GATA3 • SDHB • SYP

Walking a Hemodynamic Tightrope: Perioperative Management of Pheochromocytoma in a Patient with Hypertrophic Obstructive Cardiomyopathy (ENDO 2026) - "A reversible alpha-1 blocker, doxazosin, was chosen over phenoxybenzamine to allow for a shorter half-life, greater titratability, and a safety window to pause in case of hemodynamic instability. Atenolol was used for beta blockade. To further reduce the catecholamine burden without altering hemodynamics, metyrosine was titrated up to 4g daily over 7 days prior to surgery... This case highlights the complex cardiac hemodynamic challenges in the management of pheochromocytoma and the need for a multidisciplinary team of endocrinologists, cardiologists, surgeons, and anesthesiologists to closely coordinate care at Pheo-Para Centers of Excellence."

Clinical • Late-breaking abstract • Adrenal Cortex Carcinoma • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Endocrine Cancer • Heart Failure • Hypertension • Hypertrophic Cardiomyopathy • Neuroendocrine Tumor • Obstructive Hypertrophic Cardiomyopathy • Pulmonary Disease • Respiratory Diseases • Solid Tumor

Surgery Improves Long-Term Survival in Metastatic or Recurrent Pheochromocytoma and Paraganglioma: A 20-Year Single-Institution Review (AUA 2026) - "Treatment included surgery (47%), chemotherapy with cyclophosphamide, vincristine, and dacarbazine (27%), ^131I–metaiodobenzylguanidine radiotherapy (20%), and targeted therapy or metyrosine in select cases... This 20-year retrospective study highlights the heterogeneity of metastatic or recurrent PPGL and identifies surgical intervention as a key factor associated with improved OS. A higher PASS was predictive of poor outcome, underscoring its value as a prognostic biomarker. These findings support the role of individualized surgical management and long-term surveillance to optimize outcomes in metastatic or recurrent PPGL."

Clinical • Metastases • Review • Surgery • Adrenal Cortex Carcinoma • Neuroendocrine Tumor • Solid Tumor

Intraoperative hemodynamic collapse revealing undiagnosed pheochromocytoma in a patient with neurofibromatosis type 1 and severe cervical deformity: a case report on perioperative management. (PubMed, JA Clin Rep) - "This case highlights the importance of thorough preoperative screening and the role of anesthesiologists in detecting pheochromocytomas in asymptomatic patients with NF1 who present with intraoperative hemodynamic instability."

Journal • Anesthesia • Genetic Disorders • Neurofibromatosis • Oncology • Solid Tumor • NF1

Prevention and Management of Peptide Receptor Radionuclide Therapy-Induced Hypertensive Crisis in a Patient With Metastatic Pheochromocytoma. (PubMed, AACE Endocrinol Diabetes) - "If hypertensive crisis occurs, caution should be taken on the subsequent treatments. Additional alpha blockade right before lutetium-177 DOTATATE infusion may help; in challenging cases, short-term metyrosine use may prevent PRRT-induced hypertensive crisis."

Journal • Oncology • Solid Tumor

Experimental Investigation of Fentanyl Analgesic Potency and Its Relationship with Endogenous Adrenaline Levels in Rats. (PubMed, J Pain Res) - "Three groups of six rats each were formed: an intact group receiving fentanyl, an intact group treated with metyrosine, and an adrenalectomized group receiving fentanyl. The increase in MDA and the decrease in tGSH observed in the absence of adrenal hormones support their indirect antioxidant role. Overall, the findings indicate that fentanyl modulates catecholamine responses depending on dose and hormonal status, while its analgesic effect appears to be primarily mediated through µ-opioid receptor activation."

Journal • Preclinical • Addiction (Opioid and Alcohol) • Anesthesia • Inflammation • Pain • IL6

Biomarker discovery and drug repurposing in hepatocellular carcinoma through transcriptomics, machine learning, network pharmacology, and molecular dynamics. (PubMed, Comput Biol Chem) - "Drug-gene interaction mining mapped 78 target proteins to clinically relevant compounds, including tolrestat, alcuronium, metyrosine, and 4-phenylbutyric acid...Physicochemical and pharmacokinetic profiling further prioritised tolrestat as a computationally favourable candidate (MW = 357.35, LogP = 3.64, TPSA = 81.86 Ų), exhibiting acceptable drug-likeness, high predicted gastrointestinal absorption, and low synthetic complexity (SA = 2.34), in contrast to alcuronium (MW = 666.89, SA = 7.86), which showed multiple rule violations. Collectively, this in silico study proposes a robust diagnostic gene signature for HCC and identifies tolrestat as a promising repurposing candidate that warrants experimental validation, demonstrating the utility of integrating machine learning, network biology, and molecular simulation in translational cancer research."

Biomarker • Journal • Hepatocellular Cancer • Oncology • Solid Tumor • AKR1B10 • COLEC10 • DNASE1L3 • FGF4

Effects of Short- and Long-Term Vortioxetine Administration on Reproductive Function in Female Rats. (PubMed, Pharmaceuticals (Basel)) - " Forty-two female Wistar albino rats were randomized into seven groups (n = 6): healthy control; short-term vortioxetine; long-term vortioxetine; and the same two regimens each combined with metyrosine or metyrapone. Long-term vortioxetine induced infertility in female rats, likely mediated by corticosterone elevation consistent with hypothalamic-pituitary-adrenal axis dysregulation. These findings suggest the need to monitor reproductive risk when considering vortioxetine in women of reproductive age and warrant further mechanistic and translational studies."

Journal • Preclinical • Infertility • Sexual Disorders

Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025. (PubMed, Endocr J) - "Treatment begins with inhibiting catecholamine action using α-blockers, and if that is insufficient, metyrosine is used in combination, followed by laparoscopic tumor removal...Treatment options are selected based on the amount of remaining tumor, symptom severity, and lesion progression, including CVD chemotherapy or radionuclide therapies such as 131I-MIBG or 177Lu-DOTATATE. Genetic testing guides the management of different variants, and significant progress has been made in molecularly targeted drug trials. Therefore, further advances in individualized and long-term management are required."

Clinical guideline • Journal • Cardiovascular • Endocrine Disorders • Genetic Disorders • Hypertension • Neuroendocrine Tumor • Oncology • Pain • Solid Tumor

Metyrosine: An Unconventional Approach to Managing a Pheochromocytoma (ENDO 2025) - "She was transitioned from clevidipine to doxazosin which was up titrated to achieve a target blood pressure of 90 mmHg standing to induce orthostasis. She was seen 1 month post-surgery with normal ambulatory blood pressures. This case favors the safe use of metyrosine in the peri operative management of pheochromocytoma and should be considered for patients with an elevated risk of surgical complications."

Cardiovascular • Endocrine Cancer • Fatigue • Hematological Disorders • Hypertension • Oncology • Pain • Solid Tumor • Subarachnoid Hemorrhage

Hidden Adrenal Villains: When Pheochromocytoma Meets Steroid Therapy (ENDO 2025) - "Clinical Cases: Patient 1: 54-year-old male with recent glucocorticoid injection and oral prednisolone for right shoulder bursitis presented in hypertensive emergency with BP 213/144 mmHg, respiratory failure requiring intubation and acute renal failure...Patient 2: 48-year-old female with a kidney transplant on maintenance 5 mg prednisone daily with recent history of laparoscopic appendectomy who presented with hypertensive emergency with BP 231/110 mm/Hg, NSTEMI and diabetic ketoacidosis...Initial adrenalectomy was unsuccessful upon anesthesia induction despite conventional alpha and beta blockade, necessitating metyrosine escalation, which ultimately led to successful resection of the left adrenal nodule...Literature review over a 70-year time span of pheochromocytomas revealed that reports of glucocorticoid induced hemorrhagic pheochromocytomas is scant. In conclusion, when a patient presents with a hypertensive emergency following recent steroid exposure,..."

Acute Kidney Injury • Anesthesia • Cardiovascular • Endocrine Cancer • Hematological Disorders • Hypertension • Metabolic Disorders • Oncology • Renal Disease • Respiratory Diseases • Solid Tumor

Silent Signals: A Case of Pheochromocytoma With Negative Dotatate Uptake (ENDO 2025) - "He received pre-operative prazosin and metyrosine, which were started after completion of the dotatate scan. False-negative dotatate scans have previously been reported in cases with small tumor size (<28 mm), poorly differentiated tumors, those with low levels of SSTR-2 expression, or high uptake by healthy adrenal glands. This case underscores the significance of evaluating patients with suspected pheochromocytomas through a comprehensive lens, incorporating all clinical, biochemical, and radiologic information—even when discordant—to ensure an accurate diagnosis and appropriate treatment."

Clinical • Cardiovascular • Endocrine Cancer • Hypertension • Neuroendocrine Tumor • Oncology • Pain • Solid Tumor • GATA3 • MLANA • SSTR • SSTR2 • SYP

Catecholamine-induced Cardiomyopathy in Pheochromocytoma (ATS 2025) - "Two hours later, he became markedly hypotensive requiring initiation of epinephrine, vasopressin, and norepinephrine...He was started on prazosin. In the setting of continued marked hemodynamic variability and in preparation for tumor resection, he was started on phenoxybenzamine, a non-selective alpha blocker, and metyrosine, a catecholamine synthesis inhibitor, with subsequent initiation of carvedilol after full alpha blockade was achieved...Excision of a pheochromocytoma may be complicated by marked catecholamine surges during tumor manipulation followed by refractory hypotension after removal, challenging the management of intraoperative hemodynamics. Perioperative cardiac assessment and optimization is critical in preventing acute and long-term complications."

Cardiomyopathy • Cardiovascular • Coronary Artery Disease • Endocrine Cancer • Hematological Disorders • Hypertension • Hypotension • Myocardial Infarction • Neuroendocrine Tumor • Oncology • Pain • Solid Tumor

A CASE OF METASTATIC PHEOCHROMOCYTOMA PRESENTING AS ALTERNATING VT STORM AND BRADYARRYTHMIA - Sapan Shah (ACC 2025) - "She was cardioverted and started on intravenous amiodarone and lidocaine...Titration of alpha blockade with doxazosin resulted in hypotension; therefore, metyrosine, a catecholamine synthesis inhibitor, was initiated with low dose doxazosin...She was discharged on mexiletine therapy with a CRT-D... PPGL should be in the differential diagnosis of refractory VT. This case illustrates that the peri-operative course can be complicated by arrhythmias due to fluctuations in catecholamines and hypotension from catecholamine-induced cardiomyopathy. Appreciating the manifestations of catecholamine excess is critical to guide peri-operative management."

Clinical • Metastases • Anesthesia • Cardiomyopathy • Cardiovascular • CNS Tumor • Endocrine Cancer • Hypotension • Oncology • Solid Tumor • Ventricular Tachycardia

Pathogenesis-directed therapy of methylphenidate-induced oxidative heart damage in rats. (PubMed, Front Pharmacol) - "The current study aimed to investigate the protective effects of adenosine triphosphate (ATP), metyrosine, and melatonin on possible methylphenidate cardiotoxicity in rats using biochemical and histopathological methods. ATP, melatonin, and metirozin applications were effective to different degrees in preventing histopathological changes. This study may guide clinical trials using ATP and melatonin to prevent methylphenidate-induced myocardial injury."

Journal • Preclinical • Cardiovascular • CAT

Presentation, Management, and Outcomes of Patients with Giant Pheochromocytoma: Retrospective Cohort Study. (PubMed, J Clin Endocrinol Metab) - "Patients with giant PHEO as compared to referents were more symptomatic, had a higher degree of catecholamine excess, and had a higher rate of perioperative complications. Almost half of patients with giant PHEO developed metastases, warranting a close follow-up."

Journal • Retrospective data • Endocrine Cancer • Oncology • Solid Tumor

Stress-Related Chronic Fatigue Syndrome: A Case Report with a Positive Response to Alpha-Methyl-P-Tyrosine (AMPT) Treatment. (PubMed, Int J Mol Sci) - "Alpha-methyl-p-tyrosine (AMPT; also referred to as metyrosine) is an approved medication for the treatment of pheochromocytoma...The response of the patient to AMPT treatment highlights the relevance of pacing with regard to stressful situations and increased activity. Importantly, the results do not indicate causality between AMPT and its action on the monoamine system, and future studies should evaluate the implications of other targets."

Journal • Cardiovascular • Endocrine Cancer • Fatigue • Infectious Disease • Inflammation • Nephrology • Oncology • Solid Tumor • COMT

A Rare Case of a Renal Cell Carcinoma and Pheochromocytoma Collision Tumor (ENDO 2024) - "Lab work revealed ACTH 26.6 pg/mL (7.2-63.3), cortisol 13 ug/dL (3.7-19.4), aldosterone 23.1 ng/dL (4-31), renin 4 ng/mL/hr (0.5-4), dopamine 136 pmol/L (<240), epinephrine 121 pmol/L (<330), norepinephrine 23,666 pmol/L (1050-4800), plasma normetanephrines 12.3 nmol/L (0-0.89), plasma metanephrines <0.10 nmol/L (0-0.49), 24-hour urine normetanephrines 4,178 mcg (122-676) and 24-hour urine metanephrines 4,233mcg (224-832)...Despite aggressive preoperative alpha blockade with maximal doses of doxazosin, addition of metyrosine and other anti-hypertensives, he developed acute hypertension with adrenal mass manipulation during the procedure and then hypotension following removal...Following surgical resection, the patient was referred for genetic testing, surveillance imaging and lab testing, and treated with pembrolizumab adjuvant therapy for stage IV RCC... Although collision tumors are rare, biochemical testing to rule out a pheochromocytoma must be performed for..."

Clinical • Cardiovascular • CNS Disorders • Diabetes • Endocrine Cancer • Genito-urinary Cancer • Hematological Disorders • Hypertension • Hypotension • Insomnia • Metabolic Disorders • Mood Disorders • Movement Disorders • Oncology • Psychiatry • Renal Cell Carcinoma • Sleep Disorder • Solid Tumor • Type 2 Diabetes Mellitus

Sugar And Tumors: A Case Report On New-onset Diabetes In Metastatic Pheochromocytoma With Elevated Dopamine Levels (ENDO 2024) - "He was diagnosed with new-onset DM and started on insulin therapy in addition to metformin and jardiance. Secondary diabetes mellitus (DM) in secretory pheochromocytoma occurs in approximately 50% of cases, manifesting from mild insulin resistance to severe presentation like DKA. Epinephrine-secreting tumors contribute to glucose intolerance by activating beta receptors, thereby stimulating gluconeogenesis...Overall, understanding the complex interplay between catecholamines and glucose metabolism is crucial for the comprehensive management of patients with pheochromocytoma and secondary DM."

Case report • Clinical • Late-breaking abstract • Metastases • Cardiovascular • CNS Disorders • Diabetes • Endocrine Cancer • Gout • Hypertension • Hypoglycemia • Inflammatory Arthritis • Metabolic Disorders • Neuroendocrine Tumor • Oncology • Pain • Rheumatology • Solid Tumor

Giant Pheochromocytoma: A Retrospective Single-center Study (ENDO 2024) - "In addition to preoperative alpha-adrenergic blockade (89%), metyrosine was used in 14 (7%) patients, mostly in patients with giant PHEO (26% vs 3%, P<.0001)... Patients with giant PHEO were more symptomatic, had a higher degree of catecholamine excess, and a higher rate of perioperative complications. Almost half of patients with giant PHEO developed metastases, warranting a close follow-up.Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins."

Retrospective data • Endocrine Cancer • Oncology • Solid Tumor

The combination of doxazosin and metyrosine as a preoperative treatment for pheochromocytomas and paragangliomas. (PubMed, Endocrine) - "The combination of metyrosine and doxazosin as a preoperative treatment for PPGLs affects intraoperative circulatory hemodynamics, such as a reduced occurrence of blood pressure elevation during surgery. Further research is necessary to identify patients who will benefit most from this combination treatment."

Journal • Acute Coronary Syndrome • Cardiovascular • CNS Tumor • Endocrine Cancer • Oncology • Solid Tumor

Blasting off: persistent hypertension in a child with neuroblastoma. (PubMed, Pediatr Nephrol) - "While her blood pressure improved during the post-operative period, she continued to require multiple antihypertensive medications due to residual tumor burden. In this report, we highlight the importance of careful, multidisciplinary management to avoid peri-operative complications in patients with catecholamine-producing tumors."

Journal • Cardiovascular • CNS Tumor • Hypertension • Neuroblastoma • Oncology • Pediatrics • Solid Tumor

The Role of Adrenaline, Noradrenaline, and Cortisol in the Pathogenesis of the Analgesic Potency, Duration, and Neurotoxic Effect of Meperidine. (PubMed, Medicina (Kaunas)) - "In the meperidine (MPD) and metyrosine + meperidine (MMPD) groups, paw pain thresholds were measured before and after the treatment between the first and sixth hours (one hour apart). When cortisol levels were compared between the group in which caffeine (300 mg/kg) + meperidine + metyrapone was used for 7 days and the animals receiving caffeine (300 mg/kg) + metyrapone for 7 days, it was found that cortisol levels decreased and the latent period decreased. The current study showed that if serum ADR and cortisol levels are kept at normal levels, a longer-lasting and stronger analgesic effect can be achieved with meperidine, and epileptic seizures can be prevented."

Journal • CNS Disorders • Epilepsy • Pain

Metyrosine-associated endocrinological changes in pheochromocytoma and paraganglioma. (PubMed, Endocr Oncol) - "Adjustment of metyrosine administration may make surgical pretreatment more effective in achieving stabilized blood pressure and improving glucose metabolism. Endocrine parameters may manifest as the systemic effects of metyrosine administration."

Journal • CNS Tumor • Diabetes • Endocrine Cancer • Metabolic Disorders • Oncology • Solid Tumor • PRL