Question 14.1

A 24 year old  male is admitted to the ICU following a spontaneous intracranial haemorrhage. He is noted to have labile blood pressure that is difficult to control, and a persistent tachycardia in spite of high dose sedatives. Further investigation reveals raised plasma and urinary catecholamines.  List 4 potential  causes of the above biochemical finding in this patient.

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College Answer

  • Causes
    • Phaeochromocytoma
    • Physical stress - critical illness, hypoxia, hypercapnia, hypoglycemia
    • Use of catecholamines, amphetamine use
    • Prior h/o tricyclic use


Proudly, I can report that there is an article out there (free full text) which responds to the question, "what non-phaeochromocytoma aetiology could be causing raised plasma catecholamine levels?" Thank you for answering, David S. Goldstein.

Causes of Raised Plasma Catecholamine Levels


  • Phaeochromocytoma (adrenaline)
  • Neuroblastoma (DOPA)
  • Malignant melanoma (DOPA)
  • Menke's disease (dopamine)

Decreased clearance

  • MAO A/B inhibition
  • Altered COMT activity
  • Tricyclic antidepresant use
  • Hepatic insufficiency


Autonomic nervous system

  • Normal stress response
  • Asphyxiation
  • Morbid obesity
  • Hypoglycaemia
  • Intracranial haemorrhage (eg. SAH)
  • Acute clonidine withdrawal

Spurious results

  • Anti-parkinsonian medications
  • Amphetamine use
  • Methyldopa



Goldstein, David S., Graeme Eisenhofer, and Irwin J. Kopin. "Sources and significance of plasma levels of catechols and their metabolites in humans."Journal of Pharmacology and Experimental Therapeutics 305.3 (2003): 800-811.