metyrosine / Generic mfg. - LARVOL DELTA

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

Dopamine regulates neuroendocrine cell expansion in the developing lung (ENDO 2023) - "Treatment with Metyrosine (Met) and Benserazide (Benz) which inhibits dopamine production, resulted in a striking increase in PNEC number in NEBs as seen by expansion in Ascl1+ cells, without affecting cell proliferation. By contrast, no effect was observed with Zamicastat (Zami) which inhibits norepinephrine production. To examine whether dopamine regulated PNEC differentiation, we used the D1-like receptor antagonist, SCH-23390 and the D2-like receptor antagonist, Haloperidol in lung explant cultures, as before...Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*"

Asthma • Immunology • Pulmonary Disease • Respiratory Diseases • ASCL1

A Time and Place for Metyrosine: Successful treatment of a pheochromocytoma presenting with hypotension and multisystem organ failure (ENDO 2023) - "He was hypotensive on presentation initially on milrinone drip that was slowly tapered off. Preoperative medical stabilization is a crucial step before surgical resection of pheochromocytoma that traditionally includes an alpha blocker followed by a beta-blocking agent to reduce intra-operative hypertensive crisis. Metyrosine is an often-overlooked agent due to cost, however, should remain in our armamentarium for pheochromocytoma crisis complicated with hypotension when the patient is unable to tolerate an alpha-blocking agent. *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."

Adrenal Cortex Carcinoma • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Diabetes • Diabetic Nephropathy • Endocrine Cancer • Genito-urinary Cancer • Heart Failure • Hypertension • Hypotension • Metabolic Disorders • Neuroendocrine Tumor • Oncology • Pain • Renal Disease • Solid Tumor

The effects of metyrosine on ischemia-reperfusion-induced oxidative ovarian injury in rats: Biochemical and histopathological assessment. (PubMed, An Acad Bras Cienc) - "Our experimental findings indicate that metyrosine inhibits oxidative and pro-inflammatory damage associated with ovarian I/R in rats. These findings suggest that metyrosine could be useful in the treatment of ovarian injury associated with I/R."

Journal • Preclinical • Anesthesia • Cardiovascular • Reperfusion Injury • PTGS2

Anesthetic management in severe hemodynamic instability in pheochromocytoma resection, with intra-aortic balloon and extracorporeal membrane oxygenation: a case report (Euroanaesthesia 2023) - "Preoperative alpha adrenergic blockade (doxazosin) followed by beta (metoprolol) were initiated...Total intravenous general anesthesia: remifentanyl, fentanyl, lidocaine, propofol and rocuronium...Intubation was postponed; nitroprussiate and esmolol were started...Pulmonary aspiration of 500 ml and furosemide was administered...Metyrosine (inhibits tyrosine hydroxylase) was used as an alternative preparation, limiting the rate of catecholamine formation. In this scenario, ECMO and IAB proved to be effective in cardiac recovery allowing adrenergic blockade before tumor resection."

Clinical • Anesthesia • Cardiovascular • Congestive Heart Failure • Endocrine Cancer • Heart Failure • Hypertension • Neuroendocrine Tumor • Oncology • Ophthalmology • Solid Tumor

PHEOCHROMOCYTOMA PARAGANGLIOMA SYNDROME: AN UNCOMMON CAUSE OF STRESS CARDIOMYOPATHY (ACC-WCC 2023) - "Endocrinology added phenoxybenzamine (alpha blockade), metyrosine to block the synthesis of catecholamines...Medical Oncology initiated palliative chemotherapy (pazopanib)... We present the case of a patient in catecholamine crisis due to PCC PGL syndrome. This complex case required a multidisciplinary team to manage her acute heart failure. PCC is a rare cause of Takotsubo-like syndrome."

Back Pain • Cardiomyopathy • Cardiovascular • CNS Tumor • Congestive Heart Failure • Critical care • Endocrine Cancer • Heart Failure • Musculoskeletal Pain • Neuroendocrine Tumor • Oncology • Pain • Solid Tumor

CATECHOLAMINE INDUCED CARDIOMYOPATHY COMPLICATED BY LV THROMBUS AND STROKE - COMPLEX MANAGEMENT OF PHEOCHROMOCYTOMA (ACC-WCC 2023) - "He was diagnosed with functional metastatic pheochromocytoma based on 24-hour urine normetanephrines of 19735 ug/d and tissue biopsy that showed malignant neoplasm with neuroendocrine differentiation.Decision-making: The patient was started on a heparin drip for LV thrombus, which was complicated by heparin-induced thrombocytopenia necessitating transition to argatroban and cardioembolic stroke treated with permissive hypertension for 3 days...Metyrosine was started to curb catecholamine production that could prolong recovery of cardiac function...Post-operatively, carvedilol, sacubitril-valsartan, and empagliflozin were started and three months after resection, the patient's ejection fraction had recovered to 40-45%. Multidisciplinary discussions are critical to guiding the management of pheochromocytomas resulting in cardiomyopathy. Careful clinical monitoring and nuanced medical management is necessary to ensure sufficient catecholamine blockade is achieved while..."

Cardiomyopathy • Cardiovascular • Endocrine Cancer • Hematological Disorders • Hypertension • Hypotension • Ischemic stroke • Neuroendocrine Tumor • Oncology • Pain • Solid Tumor • Thrombocytopenia • Thrombosis

Ectopic ACTH-producing neuroendocrine tumor occurring with large recurrent metastatic pheochromocytoma: a case report. (PubMed, BMC Endocr Disord) - "We experienced a case of severe ectopic ACTH producing the largest reported recurrent malignant left PCC with liver metastases that presented positive feedback loops in the ACTH/cortisol and catecholamine/cortisol axes. Clinicians should be aware of the paradoxical response of ACTH on metyrapone treatment and possible steroid-induced catecholamine crisis."

Journal • Cardiovascular • Diabetes • Endocrine Cancer • Endocrine Disorders • Hypertension • Neuroendocrine Tumor • Oncology • Solid Tumor • SSTR • SSTR2

Successful treatment of hypertensive crisis due to pheochromocytoma during severe COVID-19 (ENDO 2022) - "During the treatment of severe COVID-19, tachycardia with atrial fibrillation developed and continuous intravenous landiolol was initiated. It is necessary to keep this disease in mind when severe blood pressure fluctuations occur even in critical illness such as severe COVID-19. Early use of alpha-blockers is needed for managing catecholamine induced hypertensive crisis and occasionally metyrosine use may have contributed to lead to overall stability."

Adrenal Cortex Carcinoma • Atrial Fibrillation • Cardiovascular • Constipation • Endocrine Cancer • Gastroenterology • Gastrointestinal Disorder • Infectious Disease • Neuroendocrine Tumor • Novel Coronavirus Disease • Oncology • Solid Tumor