Pheochromocytoma (cont.)
What else can cause the symptoms of a pheochromocytoma?
Basically, anything that can cause overactivity of the
sympathetic nervous system can be on the list to rule out when suspecting a
pheochromocytoma. The sympathetic system is the main control panel governing the
release of the "Flight or fight" response we talked about 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 attacks and spinal cord injuries can also lead to some of
the symptoms seen in pheochromocytomas.
How do you make the diagnosis of a pheochromocytoma?
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 seen, and to confuse things even further, low blood pressure can be found
is certain cases too!). 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
a doctor suspecting
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 break down products (metabolites).
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 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
123-1MIBG scan is quite
specific for pheochromocytomas.
Next: How is a pheochromocytoma treated? »
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