Pheochromo-cytoma
A pheochromocytoma is a chromaffin-cell tumor of the adrenal medulla that secretes an excessive amount of the catecholamines epinephrine and norepinephrine, which results in severe hypertension, increased metabolism, and hyperglycemia. This disorder is potentially fatal, but the prognosis is generally good with treatment.
Causes
According to some estimates, about 0.1% of newly diagnosed patients with hypertension have pheochromocytoma. Although this tumor is usually benign, it may be malignant in as many as 10% of these patients. It affects all races and both sexes, occurring primarily between ages 30 and 40. A pheochromocytoma may result from an inherited autosomal dominant trait.
Signs and symptoms
The cardinal sign of pheochromocytoma is persistent or paroxysmal hypertension. Common signs and symptoms include palpitations, tachycardia, headache, diaphoresis, pallor, warmth or flushing, paresthesia, tremor, excitation, fright, nervousness, feelings of impending doom, abdominal pain, tachypnea, nausea, and vomiting.
Clinical TipThe combination of episodic headache, diaphoresis, and palpitations with severely high blood pressure should increase suspicion of pheochromocytoma.
Postural hypotension and paradoxical response to antihypertensives are common, as are associated glycosuria, hyperglycemia, and hypermetabolism. Patients with hypermetabolism may show marked weight loss; however, some patients with pheochromocytomas are obese.
Frequency of episodes
Symptomatic episodes may recur as seldom as once every 2 months or as often as 25 times a day. They may occur spontaneously or follow certain precipitating events, such as postural change, exercise, laughing, smoking, induction of anesthesia, urination, change in environmental or body temperature, or the administration of certain medications or intra-arterial radiographic contrast media.
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