A Case of Malignant Pheochromocytoma Treated with ¹³¹I-Metaiodobenzylguanidine and Alpha-Methyl-p-Tyrosine

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A 47-year-old man had surgery for paraaortic paraganglioma in 1980 and 1985. In 1987, his urinary excretion of catecholamines and metabolites was extremely high. Scintigraphy with 131I-metaiodobenzylguanidine (MIBG) showed multiple bone and liver metastases. He was treated twice with infusions of 3.7 GBq of ¹³¹I-MIBG. After the first treatment, he had transient hypertension and pain in the back and right leg. Subsequent ¹³¹1I-MIBG scintigraphy showed that the number of metastatic tumors had decreased. The second treatment was less effective. Excess catecholamines were treated with alpha-methyl-p-tyrosine (MPT), a catecholamine synthesis inhibitor, at doses between 250 and 2000 mg/day, which significantly decreased urinary NE excretion. This is the first case treated with ¹³¹I-MIBG in Japan.