Cannabis hyperemesis triggered dangerous blood pressure spikes in a patient with adrenal tumor | Research

The takeaway

A 69-year-old man with a pheochromocytoma experienced hypertensive urgency when cannabinoid hyperemesis syndrome caused violent retching that physically compressed his adrenal tumor, triggering massive catecholamine release.

Emergency medicine clinicians, people with cannabinoid hyperemesis syndrome, endocrinologists

8 cm pheochromocytoma compressed by retching

What the researchers found

Cannabinoid-induced hyperemesis caused repeated violent retching in a patient with an 8 cm adrenal pheochromocytoma. The retching physically compressed the tumor, triggering catecholamine surges and hypertensive urgency requiring ICU admission and multiple antihypertensive medications.

Why it matters

This case illustrates an unusual but dangerous interaction between cannabinoid hyperemesis syndrome and an underlying condition. It also highlights how CHS can have consequences beyond the GI symptoms themselves.

The numbers in context

69-year-old patient, 8 cm adrenal pheochromocytoma. Required phentolamine, clevidipine infusion, then oral doxazosin and phenoxybenzamine for blood pressure control. Hyperemesis resolved within 24 hours of treatment.

How the study worked

Single case report of a 69-year-old male presenting to the emergency department with nausea, vomiting, and hypertensive urgency. History of daily cannabis use for many years with repeated hyperemesis episodes.

What this study cannot tell us

Single case report cannot establish generalized risk. This combination of conditions is extremely rare. The patient also had years of daily cannabis use.

How to read the evidence

Single case report provides the lowest level of clinical evidence but documents a novel mechanism of CHS complications.

When this study was published

2024 case report from an academic medical center

The bigger picture

While this specific combination is rare, it demonstrates how chronic cannabis use can create unexpected medical emergencies through indirect mechanisms. Clinicians treating CHS should consider whether violent retching could exacerbate other conditions.

Questions still open

Should patients with abdominal masses be screened for CHS risk if they use cannabis regularly? Could less severe retching episodes also trigger catecholamine surges?

Common questions

What is a pheochromocytoma?

A usually benign tumor of the adrenal gland that produces catecholamines (adrenaline-like hormones). When compressed or stimulated, it can release a surge of these hormones, causing dangerous blood pressure spikes.

How did cannabis hyperemesis make this worse?

The violent retching from CHS physically compressed the large adrenal tumor, squeezing it and causing massive catecholamine release that spiked blood pressure to dangerous levels.

Read the original research

Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report.

Journal of medical case reports, 18(1), 161

View on PubMed ↗Publisher’s paper ↗

Citation

Arendash, Jeffrey M; Chiu, Cornel; Wang, Jocelyn; Mihm, Fred. (2024). Cannabinoid hyperemesis and pheochromocytoma hypertensive urgency: a case report.. Journal of medical case reports, 18(1), 161. https://doi.org/10.1186/s13256-024-04497-0