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Pheochromocytoma Symptoms Diagnosis Treatment
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Pheochromocytomais an important cause of secondary
Hypertension. We have adnenal gland located at upper portion of each kidney. It is devided into
adrenal cortex and adrenal medulla. Pheochromocytoma is a tumor of Adrenal Medulla. Normal function
of adrenal medulla is to produce epinephrine or adrenaline. Which is responsible for controlling
blood pressure and to help cope with
stressful situations.
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Symptoms of Pheochromocytoma
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So majority of symptoms of pheochromocytoma are due to excess secreation of adrenaline from adrenal
medulla. Most patients of pheochromocytoma have recurrent episodes of headache, sweating and a
feeling of high anxiety. The following symptoms are listed from the most common to the least
common
Headaches (severe)
sweating Episodes (generalized)
heart palpitatios (tachycardia and palpitations)
Anxiety
nervousness (feelings of impending death)
tremors
Pain in the lower chest or upper abdomen
Nausea (with or without nausea)
Weight loss
Heat intolerance
These symptoms may come by situations which causes pressure over tumor like physical activity,
exercise, defecation, anesthesia, or change in body position.
Who should be examined for Pheochromocytoma
Those who have uncontrolled hypertension
Those who have age between 40 and 60
Those who are already taking 4 antihypertensive drugs but blood pressure is not controlable.
Those who have episodes of above symptoms
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Causes of
Pheochromocytoma
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Cause of pheochromocytoma is unknown, however some forms of this tumor runs in families like,
a-Multiple endocrine neoplasia, type II (MEN-II). In addition to a
pheochromocytoma, people with MEN-II also have thyroid cancer. Other forms of MEN-II include
pheochromocytoma with thyroid cancer and hyperparathyroidism (MEN-IIA), and
pheochromocytoma with thyroid cancer and tumors of nerves in the eyes lips,
mouth and digestive tract (MEN-IIB).
b-Neurofibromatosis 1 (NF1). Pheochromocytomas can occur in a small percentage of people with
NF1, a syndrome that includes multiple tumors in the skin (neurofibromas), pigmented skin
spots, tumors of the optic nerve of the eye, and bone diseases.
c-Von Hippel-Lindau (VHL) disease. People with this rare multisystem disorder are
at high risk of pheochromocytoma brain eye and kidney tumors.
Most pheochromocytomas are benign tumors and they dont spread to other parts of
body however some forms do show metastasis (spread) to other parts of body like lungs, bones and
brains. Usually only one gland is involved however this tumor can be present in both adrenal
glands.
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Investigations of
Pheochromocytoma
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Blood and Urine tests: We perform blood and urine tests to diagnose
pheochromocytoma. 24 hr urine collection is tested for epinephrine, norepinephrine and
dopamine. This test is called VMA. Idea is just to check level of epinephrine and its
metabolites in urine. If these are detected in urine in excess quantity, then tumor is
diagnosed.
Abdominal scan.
Now you
have diagnosed tumor by blood and urine tests, after that to find out
location of tumor, do Ultrasound, CT scan of abdomen.
Complications:
If high blood pressure remained uncontrolled it may lead to
complications of heart failure, infarction, cerebrovascular accident, vision damage and
kidney failure.
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Treatment of
Pheochromocytoma
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First treatment is to control high blood pressure with medication like Alpha Blockers and
Beta Blockers. When epinephrine is secreated by this tumor it acts on alpha and beta
receptors present on heart and blood vessels, result is vasoconstriction and
increase heart rate. Now if if we take drugs like alpha blocker and beta blocker, epinephrine
will be blocked by these drugs to act on these receptors so result is vasodilation and slow
heart rate. Common Alpha blockers are Prazosin (Minipress), Terazosin (Hytrin)
Phenoxybenzamine( Dibenzaline). Common Beta Blockers are Atenolol(Tenormin),
Carvedilol(Carveda), Metoprolol(Mepressor), Inderal.
Treatment of choice for this tumor is Surgery. After removal of this gland by surgery,
blood pressure becomes normal with a day. There are two
types of surgeries. General and Laproscopic surgery. However Surgery is not an option
for those tumors which show metastasis to other parts of body. For that we use chemotherapy
and radiations.
Whenever you have high blood pressure with any symptom, don't ignore it, you
may be the patient of Pheochromocytoma. Always contact your Doctor.
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