Phaeochromocytoma

Question 1

What is the pathophysiology of a Phaeochromocytoma?

Answer 1

Catecholamine producing tumour arising from sympathetic paraganglia
Usually found in the adrenal medulla or aortic bifurcation
Can be associated with Neurofibrimatosis and MEN2a/2b genes
Can be malignant or benign

Question 2

What is the presentation of a Phaechromocytoma?

Answer 2

Triad of - Headaches, Sweating + Tachycarda
May also have;
High BP
Palpitations
Anxiety
Abdominal pain
Heat intolerance

Question 3

What investigations can be done in a patient with a suspected Phaechromocytoma?

Answer 3

Plasma adrenaline
Urine adrenaline
Abdominal CT/MRI

Question 4

What is the management of a Phaechromocytoma?

Answer 4

Medical - Chemotherapy if malignant
Surgical - Adreneclectomy - Give α-blocker, then β-blocker pre-op.
Monitor BP post op for severe drops

Question 5

What is the presentation of a Hypertensive crisis?

Answer 5

Pallor
Pulsating headache
Feeling of impending doom
Very high BP
Cardiogenic shock
Give α-blocker