Baqsimi® (glukagon näspulver): Feokromocytom

Detailed Information

People with a history of phaeochromocytoma were excluded from the NG clinical studies.¹

NG is contraindicated in people with phaeochromocytoma because glucagon may stimulate release of catecholamines from the tumor.²

If the person develops a dramatic increase in BP, use of non-selective α-adrenergic blockade has been shown to be effective in lowering BP.²

Tumor-Induced Release of Catecholamines

Phaeochromocytomas are a rare neuroendocrine tumor usually in the adrenal medulla^3,4and less frequently occur in the form of extra-adrenal paragangliomas.³ Phaeochromocytoma tumor cells have specific glucagon-binding receptors, which are stimulated in response to glucagon administration and can cause the release of high levels of circulating catecholamines norepinephrine and epinephrine.^3,4  

Clinical presentation varies considerably in people due to the hemodynamic and metabolic actions of the catecholamines (Table 1).³ 

Table 1. Signs and Symptoms of a Phaeochromocytoma³

Abbreviation: GI = gastrointestinal.

^a Sustained or paroxysmal.

^b Rarely diarrhea.

Injectable Glucagon

Phaeochromocytomas have caused multiorgan failure and rare, life-threatening hypertensive crises as a result of very high levels of catecholamines being released in response to injectable glucagon administration.^3,4

At one time, injectable glucagon was used to confirm the diagnosis of phaeochromocytoma. This is no longer recommended due to the risk of causing a phaeochromocytoma crisis.^3,4

References

1. Data on file, Eli Lilly and Company and/or one of its subsidiaries.

2. Baqsimi [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.

3. Eisenhofer G, Rivers G, Rosas AL, et al. Adverse drug reactions in patients with phaeochromocytoma: incidence, prevention and management. Drug Safety. 2007;30(11)1031-1062. https://doi.org/10.2165/00002018-200730110-00004

4. Hosseinnezhad A, Black R, Aeddula N, et al. Glucagon-induced pheochromocytoma crisis. Endocr Pract. 2011;17(3):e51-e54. https://doi.org/10.4158/EP10388.CR

Glossary

BP = blood pressure

IV = intravenous

NG = nasal glucagon (glucagon nasal powder)