Pheochromocytoma

Question 1

Signs of pheochromocytoma that merit screening

Answer 1

episodic headaches,

diaphoresis,

tachycardia hyperadrenergic spells (nonexertional palpitations, pallor)

resistant HTN

onset of HTN at young age

Question 2

Need to screen for pheochromocytoma based on family history risk factors for pheochromocytoma

Answer 2

family history of pheochromocytoma predisposing familial syndrome (MEN2 and NF1 and VHL)

Question 3

other reasons to screen for pheochromocytoma

Answer 3

adrenal incidentaloma on imaging pressor response during surgery or anethesia idiopathic dilated cardiomyopathy

Question 4

if someone has unexplained idiopathic dilated cardiomyopathy need to consider

Answer 4

pheochromocytoma

Question 5

if someone has disproportionate pressor response in surgery or gets afib with RVR need to consider

Answer 5

pheochromocytoma

Question 6

if someone w/ headaches and anxiety develops hypertensive crisis and flash pulm edema or afib with RVR after anesthesia need to consider

Answer 6

pheochromocytoma

Question 7

when do we see pheochromocytoma

Answer 7

>40 yrs but diagnosed at 50’s

Question 8

sometimes symptoms of pheochromocytoma are unmasked by:

Answer 8

precipitating factor like anesthesia induction, pregnancy and physical activity

Question 9

classic triad of pheochromocytoma is

Answer 9

headache, diaphoresis, palpitations 50% have paroxysmal HTN 95% of tumors are in the abdomen 85% are in adrenals.

Question 10

10 percent rule of adrenal pheochromocytoma

Answer 10

10% in adrenals 10% malignant 10% are bilateral

Question 11

test to order if you have highest pretest probability

Answer 11

order both urine and plasma metanephrines and (catecholamines too)

Question 12

in pts who have low pretest probability, should order

Answer 12

urine catecholamines and if negative can rule out pheochromocytoma

Question 13

If positive urine or serum catecholamines and metanephrines, need to follow this with

Answer 13

abdominal imaging CT scan or MRI

Question 14

If imaging is unremarkable after positive screening testing with catecholamines/metanephrines and concerned for pheochromocytoma, need to look for:

Answer 14

radiolabeled metaiodobenzylguanidine to locate tumor

Question 15

Treatment of pheochromocytoma is:

Answer 15

pre operative alpha blockade (phenoxybenzamine 10 mg PO bid) followed by low dose beta blocker (propranolol) titrated to heart rate and surgical resection and adrenalectomy (not always curative)

Question 16

Algorithm for pheochromocytoma

Answer 16