Pheochromocytoma

Question 1

Definition

Answer 1

Adrenal medullary tumour that secretes catecholamines (NAd, Adr)
(Secondary cause of hypertension = but RARER than Conns)

Question 2

Epidemiology

Answer 2

30 - 50 years

Question 3

Aetiology

Answer 3

MEN 2A+2B
Neurofibromatosis (tumours deposited along nerve myelin sheath)
Von-Hippel Lindau Disease

Question 4

Triggers include….

Answer 4

Stress
Physical exertion
Certain food that contains thymine

Question 5

Signs

Answer 5

Hypertension
Pallor
V. Sweaty
Tachycardic

Question 6

Symptoms

Answer 6

Headache
Profuse sweating
Palpitations
Tremor

Question 7

Diagnosis

Answer 7

FIRST LINE: 24-hour urinary total metanepherine
GOLD STANDARD = Plasma metanepherines + normetanephrines = HIGH = More sensitive readings than NAd/Adr; longer 1/2 life
CT - look for tumour

Question 8

Treatment

Answer 8

FIRST LINE: Alpha blockers (PHENOXYBENZAMINE) = 10-14 days to allow BP to normalise THEN
Beta blockers (e.g ATENOLOL)
This prevents vasoconstriction

If surgery possible = EXCISE TUMOUR

Question 9

HTN CRISIS Causes

Answer 9

Tricyclic antidepressants
Opiates
XR contrast

Question 10

HTN crisis BP

Answer 10

180/120 + BP

Question 11

HTN CRISIS Treatment

Answer 11

PHENTOLAMINE (Alpha Blocker)