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.
- Paroxysmal spells (5 Ps mnemonic):
- Pressure: Sudden increase in blood pressure
- Pain: Headache, chest, abdominal pain
Additional symptoms of pheochromocytoma diagnosis:
- Weight loss
- Shortness of breath
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.
- Orthostatic hypotension
- Café au lait spots
- Lisch nodules of the eye
- Grade II–IV retinopathy
- Transient ischemic attacks/stroke
- Gastrointestinal crisis
- Diabetes mellitus or insipidus
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
- 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
- Drugs that may alter lab results:
- Increased by:
- Tricyclic antidepressants
- Monoamine oxidase inhibitors (MAOIs)
- Clonidine or other drug withdrawal
- Ethanol or ethanol withdrawal
- Decreased by:
- Central α2-agonists
- Disorders that may alter lab results: Major physical stress (e.g., surgery, stroke, myocardial infarction, congestive heart failure)
Imaging for pheochromocytoma diagnosis
- Abdominal image: Magnetic resonance imaging is preferable to computed tomography (CT).
- I-metaiodobenzylguanidine (MIBG) scan
- Pentetreotide scan
When using CT, avoid contrast or protect with adrenergic blockade to avoid precipitating a hypertensive crisis.
Clonidine-suppression test distinguishes between pheochromocytoma and essential HTN when urine and plasma tests are equivocal.
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
- Labile essential hypertension
- Anxiety and panic attacks
- Paroxysmal cardiac arrhythmia
- Menopausal syndrome
- Withdrawal of adrenergic-inhibiting medications
- Migraine headache
- Amphetamine or cocaine use
- Sympathomimetic ingestion