Pheochromocytoma

Question 1

Essentials of Dx

Answer 1

“Attacks” of headache, perspiration, palpitations/tachycardia = triad of pheochromocytoma
Anxiety
Hypertension, frequently sustained but often paroxysmal, especially during surgery or delivery
Elevated urinary catecholamines or their metabolites
Normal serum T4 & TSH

Question 2

General Considerations

Answer 2

Arises from adrenal medulla
Secretes epinephrine and norepinephrine, thus triad
Deadly & deceptive
Account for <0.4% of hypertension cases
Occur in people of all races, usually less common in blacks
Peak incidence is from the 3rd to 5th decades of life

Question 3

Signs and Symptoms

Answer 3

Triad = Headaches
Palpitations &Tachycardia
Diaphoresis
Severe hypertension
Frequency may vary from monthly to several times/day
Duration may vary from seconds to hours
Other symptoms may occur:
Increased serum glucose
Tremor
Nausea
Weakness
Anxiety, sense of doom
Epigastric pain
Flank pain
Constipation

Question 4

DD

Answer 4

Thyrotoxicosis
Essential hypertension
Renal hypertension
Anxiety attacks
Cocaine or amphetamine use
Clonidine withdrawal

Question 5

Dx Workup

Answer 5

Plasma metanephrines
if negative, r/o pheo
if elevated, move on to 24hr urine collection (can use overnight or shorter collection) urine metanephrines make more positive dx of pheo
>2.2mcg total metanephrine per 1mg crt

Question 6

Management

Answer 6

Refer to Endo

Surgical removal of adrenal medulla is tx of choice