To the Editor.
—In the January 1984 Archives, Sloand and Taylor Thompson1 presented a case of unknown pheochromocytoma without histologic evidence of heart disease, in which propranolol hydrochloride—induced pulmonary edema and shock, leading to death. It is known that propranolol may cause pulmonary edema in patients with pheochromocytoma without having a previous α-blockade.2 As propranolol is a nonspecific betablocking drug, its administration in these patients may leave α-adrenergic effects unopposed.1,2 This could result in arterial vasoconstriction causing afterload increase and heart failure, that may lead to pulmonary edema2 and cardiogenic shock.1 Sloand and Taylor Thompson1 suggested that the use of a selective β1-blocker such as metoprolol tartrate, would be a theoretical alternative to propranolol. Additionally, propranolol has a negative inotropic effect and because of this action, it has been reported to precipitate severe heart failure in a patient with a pheochromocytoma plus a cardiomyopathy, that was under a-adrenergic
Solares G, Ramos F, Martin-Durán R, Ares M. Is Amiodarone an Alternative to Beta-Blockers to Treat Supraventricular Tachycardias in Pheochromocytoma?. Arch Intern Med. 1986;146(10):2085. doi:10.1001/archinte.1986.00360220267048