Acute variceal bleeding in a patient with phaeochromocytoma: the critical choice of vasoactive therapy.
Jessica Satya Graha, Joshua Haron Abasszade, Teagan Rose Wanigaratne et al.
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Case in brief
A woman in her late 70s with a known left-sided phaeochromocytoma experienced acute variceal bleeding, likely due to cirrhosis. Due to the risk of hypertensive crisis, terlipressin was not used. Instead, octreotide was administered alongside optimized alpha-blockade and endoscopic variceal ligation, resulting in successful hemorrhage control without cardiovascular complications.
What made this case unusual
The case is notable for the contraindication of terlipressin in a patient with phaeochromocytoma, necessitating the use of octreotide as an alternative vasoactive therapy.
Diagnostic / clinical pearl
Clinicians should be aware of the contraindications of standard vasoactive agents in patients with rare comorbidities, such as phaeochromocytoma, to avoid severe complications.
Why it matters
This case underscores the importance of individualized treatment strategies in complex patients, particularly when standard therapies may pose significant risks.