Pheochromocytoma: Difference between revisions
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*Paroxysms usually lasting <1 hour of the following symptoms: | *Paroxysms usually lasting <1 hour of the following symptoms: | ||
**[[Headache]] | **[[Headache]] | ||
**[[Tremor]] | |||
**Alternating periods of normal and elevated blood pressure, and can cause resistant [[hypertension]] and [[hypertensive emergency]] | **Alternating periods of normal and elevated blood pressure, and can cause resistant [[hypertension]] and [[hypertensive emergency]] | ||
**[[Tachycardia]] | **[[Tachycardia]] | ||
Revision as of 22:46, 15 January 2021
Background
- Rare tumor arising from chromaffin cells in adrenal medulla or other paraganglia in the body
- Increased catecholamine production leading to its clinical manifestations
Clinical Features
- Paroxysms usually lasting <1 hour of the following symptoms:
- Headache
- Tremor
- Alternating periods of normal and elevated blood pressure, and can cause resistant hypertension and hypertensive emergency
- Tachycardia
- Flushed skin
- Palpitations
- Diaphoresis
- Anxiety
- Weight loss
Differential Diagnosis
Hypertension
- Hypertensive emergency
- Stroke
- Sympathetic crashing acute pulmonary edema
- Ischemic stroke
- Intracranial hemorrhage
- Preeclampsia/Eclampsia
- Autonomic dysreflexia
- Scleroderma renal crisis
- Acute glomerulonephritis
- Type- I myocardial infarction
- Volume overload
- Urinary obstruction
- Drug use or overdose (e.g stimulants, especially alcohol, cocaine, or Synthroid)
- Renal Artery Stenosis
- Nephritic and nephrotic syndrome
- Polycystic kidney disease
- Tyramine reaction
- Cushing's syndrome
- Obstructive sleep apnea
- Pheochromocytoma
- Hyperaldosteronism
- Hyperthyroidism
- Anxiety
- Pain
- Oral contraceptive use
Evaluation
- Plasma free metanephrines
- Urinary fractionated metanephrines
- CT imaging to localize tumor
- General lab features include hyperglycemia, hypercalcemia, and erythrocytosis
Management
- Hypertensive crisis:
- α blockade with phenoxybenzamine or phentolamine acutely[1]
- Phentolamine: 5mg IM/IV q2-4h PRN
- Nitroprusside
- Nicardipine
- α blockade with phenoxybenzamine or phentolamine acutely[1]
- Beta blockade can be started 2 days later
- Eventual surgical resection of tumor
Disposition
- Admission to a monitored setting
See Also
External Links
References
- ↑ WJ Elliott, J Varon. Drugs used for the treatment of hypertensive emergencies. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on January 11, 2016.)