Phaeochromocytoma ****

Question 1

What is it?

Answer 1

A tumour of the adrenal medulla

Question 2

What does it secrete?

Is it usually benign or malignant?

Answer 2

Catecholamine

Benign

Question 3

What is meant by the rule of 10s

Answer 3

10% are extra-adrenal
10% are malignant 
10% are familial
10% are bilateral
10% are in children

Question 4

Catecholamines:

They are normally made from the adrenal gland.

Give some examples of them?

Why are they released?

Answer 4

Dopamine; norepinephrine; and epinephrine

When you are physically or emotionally stressed.

Question 5

S+S:

The typical triad can be remembered using PHAE mneumonic?

Other symptoms:

• Hypertension - why do they get it? how does this present?
• What does hypertension lead to in the eye?
• Why do they develop DM?

Answer 5

Palpitations and tachycardia (due to beta-1 receptor activation via adrenaline)
HeadAche
Excess sweat

Due to alpha-1 receptor activation via adrenaline Paroxysmal and sustained
Retinopathy

Catecholamines increase glycogenolysis and reduces insulin secretion

Question 6

Other causes of paroxysmal hypertension

Answer 6

Drugs especially cocaine

Panic disorder

Question 7

Investigations:

Why are serum metadrenalines and nometadrenalines measured instead of serum catecholamines?

What is an alternative?

What imaging can be done?

Answer 7

They care catecholamine metabolites and are always high.

Serum catecholamines may be normal due to their episodic release

24-hour urine

CT and MRI

Question 8

Management:

Alpha blockade is used for_____?

Beta blockade is used for ______?

Why is beta used before alpha?***

Main Rx?

Answer 8

Helps hypertension

For HR

It can lead to a hypertensive crisis - THIS IS AN EMERGENCY AND THEY NEED ICU ADMISSION

Adrenalectomy