Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
What else can cause the symptoms of a pheochromocytoma?
Basically, anything that can cause over activity of the sympathetic nervous system can
be on the list of diagnoses to rule out when suspecting a
pheochromocytoma. The sympathetic system is the main control panel governing the
release of the "flight or fight" response in response to stress or fear, as
mentioned above. Things that can stimulate this include drugs (even excessive
use of decongestants should be considered); withdrawal from drugs (such as
suddenly stopping certain blood pressure medications); panic attacks, and
spinal
cord injuries are among the many conditions that can also lead to some of the
symptoms seen in pheochromocytomas.
How is pheochromocytoma diagnosed?
Pheochromocytoma is a possibility in anyone with the classic triad of
symptoms -- headache, sweating, and heart palpitations -- especially when there
is high blood pressure (though high blood pressure is not always present). A
physician becomes more suspicious if the patient is young and has no other risk
factors or habits that may cause these findings.
Perhaps the patient knows their family history well and can inform their
doctor of pheochromocytoma(s) diagnosed in family members. Consequently, a
doctor suspecting familial pheochromocytoma can go straight to genetic testing.
However, in most cases, if suspicion is high, the physician proceeds with a
series of tests to measure the culprit hormones and their breakdown products
(metabolites) listed below.
First, hormones such as catecholamines and metanephrines are measured in a 24
hour urine collection, and metanephrines may also be measured in the blood. If
these are greater than 2 times the normal level, imaging studies are usually
done to look at the adrenal glands.
If imaging with MRI or
CT scans of the adrenal glands shows a mass in the
gland (or outside it), surgery may be done. If it is not clear that the mass is
actually functional and related to the findings clinically, or if there is no
mass seen on imaging, another test can be performed. This test called a
131-I-MIBG scan is quite specific for pheochromocytomas. In this test a
radioactive iodine molecule is injected into the bloodstream and localized in
the area of the tumor, allowing visualization of the pheochromocytoma on imaging
studies.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
There are four major types of thyroid cancer: papillary, follicular, medullary, and anaplastic thyroid cancer. Tumors on the thyroid are referred to as thyroid nodules. Symptoms of thyroid cancer include swollen lymph nodes, pain in the throat, difficulty swallowing, hoarseness, and a lump near the Adam's apple. Treatment usually involves chemotherapy, surgery, radioactive iodine, hormone treatment or external radiation and depends upon the type of thyroid cancer, the patient's age, the tumor size, and whether the cancer has metastasized.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Palpitations can be relieved in many patients by stress reduction, stopping cigarettes, and reduction of caffeine and alcohol.
Tremor is the involuntary movements of one or more parts of the body. Causes of tremor include neurological disorders, neurodegenerative diseases, drugs, mercury poisoning, overactive thyroid and liver failure. There are several types of tremor. Treatment depends upon the type of tremor and availability of medications for the condition.
Genetic disease is a disorder or condition caused by abnormalities in a person's genome. Types of genetic inheritance include single inheritance (for example, cystic fibrosis, sickle cell anemia, Marfan syndrome, and hemochromatosis), multifactoral inheritance, chromosome abnormalities (for example, Turner syndrome, and Klinefelter syndrome), and mitochondrial inheritance (for example, epilepsy and dementia).
Your health care provider may refer you to a genetic professional. Universities and medical centers also often have affiliated genetic professionals, or can provide referrals to a genetic professional or genetics clinic. Genetic counseling provides patients and family members the tools to make the right choice in regard to test for a disease or condition.
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