How is Pheochromocytoma diagnosis arrived?
- Symptoms for pheochromocytoma diagnosis
- Tests for pheochromocytoma diagnosis
Symptoms for pheochromocytoma diagnosis
- “Classic triad” of Pheochromocytoma diagnosis symptoms includes headache, palpitations, and diaphoresis.
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Paroxysmal spells (5 Ps mnemonic):
- Pressure: Sudden increase in blood pressure
- Pain: Headache, chest, abdominal pain
- Perspiration
- Palpitation
- PalloR
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Additional symptoms of pheochromocytoma diagnosis:
- Constipation
- Tremor
- Weight loss
- Anxiety
- Paresthesias
- Flushing
- Shortness of breath
- Nausea/vomiting
Pediatric Considerations in pheochromocytoma diagnosis
Profuse sweating common in children and helps in pheochromocytoma diagnosis
Physical symptoms for pheochromocytoma diagnosis.
- Hypertension (HTN): Paroxysmal in 1/2 of affected patients; most common clinical sign in pheochromocytoma diagnosis.
- Tachyarrhythmias
- Orthostatic hypotension
- Café au lait spots
- Lisch nodules of the eye
- Grade II–IV retinopathy
- Transient ischemic attacks/stroke
- Cardiomyopathy
- Gastrointestinal crisis
- Diabetes mellitus or insipidus
- Fever
- Hypercalcemia
- Erythrocytosis
Alert after pheochromocytoma diagnosis.
Sudden death may occur in patients with an undiagnosed tumor who undergo surgery or biopsy.
Pheochromocytoma diagnosis – Tests & Interpretation
Lab for pheochromocytoma diagnosis
Initial lab tests for pheochromocytoma diagnosis
- Elevated 24-hour urine or plasma metanephrine
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Elevated 24-hour urine or plasma catecholamines:
- Blood pressure (BP) must be recorded during plasma sampling for catecholamines. Pheochro-mocytoma cannot be excluded if normal catecholamine values are obtained when the patient is normotensive and asymptomatic (1)[A].
- Elevated 24-hour urine VMA
- Plasma catecholamines and metanephrines must be measured when patient is at rest (1)[A].
Follow-Up & Special Considerations for pheochromocytoma diagnosis
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Drugs that may alter lab results:
-
Increased by:
- Phenoxybenzamine
- Tricyclic antidepressants
- Labetalol
- Methyldopa
- Monoamine oxidase inhibitors (MAOIs)
- Amphetamines
- Cocaine
- Clonidine or other drug withdrawal
- Ethanol or ethanol withdrawal
- Sotalol
- Levodopa
- Acetaminophen
-
Decreased by:
- Central α2-agonists
- Reserpine
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- Disorders that may alter lab results: Major physical stress (e.g., surgery, stroke, myocardial infarction, congestive heart failure)
Imaging for pheochromocytoma diagnosis
Initial approach
- Abdominal image: Magnetic resonance imaging is preferable to computed tomography (CT).
- I-metaiodobenzylguanidine (MIBG) scan
- Pentetreotide scan
Alert
When using CT, avoid contrast or protect with adrenergic blockade to avoid precipitating a hypertensive crisis.
Diagnostic Procedures/Surgery
Clonidine-suppression test distinguishes between pheochromocytoma and essential HTN when urine and plasma tests are equivocal.
Pathological Findings
A catecholamine-producing tumor in the adrenal medulla, para-aortic sympathetic chain, wall of the urinary bladder, or sympathetic chain in the neck or mediastinum
Differential Diagnosis
- Labile essential hypertension
- Anxiety and panic attacks
- Paroxysmal cardiac arrhythmia
-
ThyrotoxicosisP.993
- Menopausal syndrome
- Hypoglycemia
- Mastocytosis
- Withdrawal of adrenergic-inhibiting medications
- Angina
- Hyperventilation
- Migraine headache
- Amphetamine or cocaine use
- Sympathomimetic ingestion