Pheochromocytoma

Question 1

what is are pheochromocytomas?

Answer 1

catecholamine-secreting tumors of neuroendocrine cells of the adrenal medulla

(to do with the sympathetic nervous system)

Question 2

what are some of them associated with?

Answer 2

multiple endocrine neoplasia

Question 3

symptoms (catecholamine excess)

Answer 3

headache, palpitations, sweating, anxiety, weight loss, nausea

Question 4

signs (catecholamine excess)

Answer 4

hypertension, tachycardia, pallor

Question 5

DDx

Answer 5

anxiety disorders
benzodiazepam withdrawal
hyperthyroidism

Question 6

what would the 24hr urine collection be looking for?

Answer 6

catecholamines (NA, A, DA)
- noradrenaline, adrenaline and dopamine

metabolites

• metanephrines
• nometanephrines

Question 7

what confirms Dx?

Answer 7

raised levels of plasma catecholamines

Question 8

how to localise the tumor?

Answer 8

imaging - CT/MRI

Question 9

Mx

Answer 9

surgical excision under alpha (and beta?) blockade, using phenoxybenzamine (and propranolol)

blockade is started pre-op

Question 10

why must they be alpha-blocked pre-op?

Answer 10

to prevent hypertensive crisis during surgery