{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T09:01:02Z","timestamp":1792918862699,"version":"4.5.0"},"reference-count":22,"publisher":"The Endocrine Society","issue":"6","license":[{"start":{"date-parts":[[2021,3,6]],"date-time":"2021-03-06T00:00:00Z","timestamp":1614988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23DK121888"],"award-info":[{"award-number":["K23DK121888"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Treatment of pheochromocytoma and paraganglioma (PPGL) requires preintervention titration of alpha- and beta-adrenergic blockade, but patients may still be at risk for complications from catecholamine excess. Metyrosine decreases catecholamine production, making it an attractive therapeutic adjunct for select patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Evidence Acquisition<\/jats:title>\n                  <jats:p>A systematic literature review was performed (Ovid Medline and Scopus databases) on December 17, 2019, including studies with humans and original data. Studies with 10 or more patients on metyrosine for PPGL were included. Studies were screened for overlapping populations, and the most comprehensive study was included. The references of included studies were reviewed for additional data. Patient data from our institution between 2000 and 2015 were also reviewed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Evidence Synthesis<\/jats:title>\n                  <jats:p>Metyrosine is well tolerated when used for a short course and can improve intraoperative outcomes in PPGL. Metyrosine should be considered when a difficult PPGL resection is expected (eg, pericardiac paraganglioma, abdominal paraganglioma with great vessel involvement), a large release of catecholamines is anticipated (eg, ablative therapy, chemotherapy), or when standard alpha- and beta-adrenergic blockade are not tolerated or cannot adequately control hypertension. Side effects are generally mild and self-limited, with sedation in a majority of patients. Extrapyramidal side effects are rare but can limit use of metyrosine. Because of its expense and limited availability, metyrosine use should be carefully planned and timed in relation to surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Metyrosine is a safe addition to traditional alpha- and beta-adrenergic blockade and should be considered in those patients with PPGL at high risk for acute release of catecholamines.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgab130","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T04:19:29Z","timestamp":1615436369000},"page":"e2393-e2401","source":"Crossref","is-referenced-by-count":47,"title":["The Role for Metyrosine in the Treatment of Patients With Pheochromocytoma and Paraganglioma"],"prefix":"10.1210","volume":"106","author":[{"given":"Lucinda M","family":"Gruber","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Jasim","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism and Lipid Research, Department of Internal Medicine Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Ducharme-Smith","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toby","family":"Weingarten","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"William F","family":"Young","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9332-2524","authenticated-orcid":false,"given":"Irina","family":"Bancos","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2021,3,6]]},"reference":[{"key":"2021122205123768000_B1","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1001\/jama.1927.02690130035013","article-title":"Paroxysmal hypertension with tumor of retroperitoneal nerve: report of case","volume":"89","author":"Mayo","year":"1928","journal-title":"JAMA"},{"key":"2021122205123768000_B2","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.ijsu.2018.11.019","article-title":"Risk factors for postoperative severe morbidity after pheochromocytoma surgery: a single center retrospective analysis of 262 patients","volume":"60","author":"Bai","year":"2018","journal-title":"Int J Surg"},{"issue":"2","key":"2021122205123768000_B3","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1055\/s-0032-1331217","article-title":"Mortality associated with phaeochromocytoma","volume":"45","author":"Prejbisz","year":"2013","journal-title":"Horm Metab Res"},{"issue":"5","key":"2021122205123768000_B4","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1111\/cen.13434","article-title":"Outcomes of patients with metastatic phaeochromocytoma and paraganglioma: a systematic review and meta-analysis","volume":"87","author":"Hamidi","year":"2017","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"9","key":"2021122205123768000_B5","doi-asserted-by":"crossref","first-page":"3296","DOI":"10.1210\/jc.2017-00992","article-title":"Malignant pheochromocytoma and paraganglioma: 272 patients over 55 years","volume":"102","author":"Hamidi","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"2021122205123768000_B6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijsu.2017.08.026","article-title":"Perioperative hemodynamics and outcomes of patients on metyrosine undergoing resection of pheochromocytoma or paraganglioma","volume":"46","author":"Butz","year":"2017","journal-title":"Int J Surg"},{"issue":"2","key":"2021122205123768000_B7","first-page":"360","article-title":"Preoperative metyrosine improves cardiovascular outcomes for patients undergoing surgery for pheochromocytoma and paraganglioma","volume":"44","author":"Wachtel","year":"2015","journal-title":"Pancreas"},{"issue":"3","key":"2021122205123768000_B8","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1172\/JCI105754","article-title":"Biochemical and pharmacologic effects of alpha-methyltyrosine in man","volume":"47","author":"Engelman","year":"1968","journal-title":"J Clin Invest"},{"issue":"3","key":"2021122205123768000_B9","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1507\/endocrj.EJ17-0276","article-title":"Efficacy and safety of metyrosine in pheochromocytoma\/paraganglioma: a multi-center trial in Japan","volume":"65","author":"Naruse","year":"2018","journal-title":"Endocr J"},{"issue":"5","key":"2021122205123768000_B10","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1097\/00000658-199011000-00010","article-title":"Surgical management of pheochromocytoma with the use of metyrosine","volume":"212","author":"Perry","year":"1990","journal-title":"Ann Surg"},{"issue":"3","key":"2021122205123768000_B11","first-page":"230","article-title":"Preoperative treatment and survival of patients with pheochromocytomas","volume":"86","author":"Sand","year":"1997","journal-title":"Ann Chir Gynaecol"},{"issue":"8","key":"2021122205123768000_B12","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1001\/archinte.1997.00440290087009","article-title":"Metyrosine and pheochromocytoma","volume":"157","author":"Steinsapir","year":"1997","journal-title":"Arch Intern Med"},{"key":"2021122205123768000_B13","author":"Metyrosine.","year":"2020"},{"key":"2021122205123768000_B14","volume-title":"Demser (metyrosine) capsules","author":"FPO","year":"2017"},{"issue":"7","key":"2021122205123768000_B15","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/BF01476565","article-title":"Malignant pheochromocytoma. Effect of oral alpha-methyl-p-tyrosine upon catecholamine metabolism","volume":"57","author":"Hengstmann","year":"1979","journal-title":"Klin Wochenschr"},{"issue":"2","key":"2021122205123768000_B16","first-page":"65","article-title":"Alpha-methyl-p-tyrosine in the symptomatic treatment of patients with malignant phaeochromocytoma","volume":"57","author":"Py\u00f6r\u00e4l\u00e4","year":"1968","journal-title":"Ann Med Intern Fenn"},{"issue":"3","key":"2021122205123768000_B17","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1172\/JCI105753","article-title":"Metabolism of alpha-methyltyrosine in man: relationship to its potency as an inhibitor of catecholamine biosynthesis","volume":"47","author":"Engelman","year":"1968","journal-title":"J Clin Invest"},{"issue":"6","key":"2021122205123768000_B18","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1001\/archpsyc.1977.01770180035002","article-title":"Inhibition of dopamine synthesis in chronic schizophrenia. Clinical ineffectiveness of metyrosine","volume":"34","author":"Nasrallah","year":"1977","journal-title":"Arch Gen Psychiatry"},{"issue":"3","key":"2021122205123768000_B19","first-page":"148","article-title":"Extrapyramidal symptoms associated with antidepressants-a review of the literature and an analysis of spontaneous reports","volume":"22","author":"Madhusoodanan","year":"2010","journal-title":"Ann Clin Psychiatry"},{"key":"2021122205123768000_B20","article-title":"The role of catecholamines in neural tube closure and head flexure formation in the chick embryo","author":"Kvist","year":"1975","journal-title":"Teratology"},{"key":"2021122205123768000_B21","author":"GoodRx.com.","year":"2019"},{"key":"2021122205123768000_B22","author":"Drugs.com."}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgab130\/37118922\/dgab130.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/106\/6\/e2393\/41851617\/dgab130.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/106\/6\/e2393\/41851617\/dgab130.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T05:17:11Z","timestamp":1640150231000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/106\/6\/e2393\/6161333"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,6]]},"references-count":22,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,3,6]]},"published-print":{"date-parts":[[2021,5,13]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgab130","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,6,1]]},"published":{"date-parts":[[2021,3,6]]}}}