Pheochromocytoma Symptoms Diagnosis And Treatment

Pheochromocytoma is an important cause of secondary Hypertension. We have adrenal gland located at an upper portion of each kidney. It is divided into an adrenal cortex and adrenal medulla. Pheochromocytoma is a tumor of Adrenal Medulla. The 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.

So the majority of symptoms of pheochromocytoma are due to excess secretion of adrenaline from the adrenal medulla. Most patients with pheochromocytoma have recurrent episodes of a 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 palpitations (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 cause 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 controllable.

Those who have episodes of above symptoms

The cause of pheochromocytoma is unknown, however, some forms of this tumor run 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 don't spread to other parts of the body however some forms do show metastasis (spread) to other parts of the body like lungs, bones, and brains. Usually, only one gland is involved however this tumor can be present in both adrenal glands.

Investigations:

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. An idea is just to check the level of epinephrine and its metabolites in urine. If these are detected in urine in excess quantity, then the tumor is diagnosed.

Abdominal scan.

Now you have diagnosed tumor by blood and urine tests, after that to find out the location of the tumor, do Ultrasound, CT scan of the abdomen.

Complications:

If high blood pressure remained uncontrolled it may lead to complications of heart failure, infarction, cerebrovascular accident, vision damage and kidney failure.

Treatment:

The first treatment is to control high blood pressure with medication like Alpha Blockers and Beta Blockers. When epinephrine is secreted by this tumor it acts on alpha and beta receptors present on heart and blood vessels, the result is vasoconstriction and increase heart rate. Now if we take drugs like an alpha blocker and the beta blocker, epinephrine will be blocked by these drugs to act on these receptors so the 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 Laparoscopic surgery. However, Surgery is not an option for those tumors which show metastasis to other parts of the 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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