Not Easily Diagnosed
First your doctor must become suspicious of pheochromocytoma and then order the appropriate tests. 1 in 1000 hypertensive people have it which seems rather rare until you consider that there are 50,000,000 with high blood pressure. It follows that there are more than 50,000 people who have it.
80% are found on the upper part of the kidney, 20% are elsewhere usually in deep tissue and not easily demonstrated.
Those on the kidney appear equally in both sexes and 10% of these are bilateral but 20% are bilateral in children. 95% of all are benign but of the 20% not on the kidney, more (30%) are malignant. The maximum incidence is between the 30's and 50's but occur at all ages.
The hypertension is caused by the secretion of epinephrine (adrenalin) and/or norepinephrine and dopamine or dopa.
Signs and Symptoms
What would make your doctor suspicious of pheochromocytoma? Well, hypertension first of all. Should all hypertensive patients be screened? Frankly, yes. This is usually done when high blood pressure is first diagnosed.
Secondly, suspicious symptoms occurring in an episodic manner would raise a flag. This is because 50% of these tumors secrete their pressure raising products in episodes. But don't forget the 45% that secrete all the time. 5% of them do not cause hypertension. Those who can take their own blood pressure can pick this tumor up very easily. See How To Take Blood Pressure
Since average size is a little over 2 inches they are rarely large enough to be felt by the examiner. Nor are they large enough to cause symptoms by pressure or obstruction.
Common symptoms: Usually during an episode.
- Severe headache
- Epigastric (stomach) pain
- Visual disturbances
- Paresthesias (disturbances of sensation)
- A sense of impending doom (not entirely false, either)
Common Signs: Usually during an episode.
- Tachycardia (rapid heartbeat)
- Diaphoresis (sweating)
- Postural hypotension (BP falls when stand up)
- tachypnea (rapid breathing)
- Cold and clammy skin
- Dyspnea (labored breathing)
Physical examination is usually quite normal unless the patient is having an episode at the time of the exam. The retinal changes and the enlargement of the heart are often less than expected although the hypertension is usually fairly severe.
Hypertension, especially of the episodic type, episodes of symptoms and some laboratory abnormalities including urinary levels of epinephrine and norepinephrine and their metabolic products help make the diagnosis. X-rays including CAT and MRI are helpful as well as nuclear imaging. There are other imaging tests which should be avoided because they can precipitate a crisis. Provocative tests should not be done.
Surgical removal after proper preparation to control blood pressure.
Doctor’s Practical Guide
95% of these pheochromocytoma tumors are classified as benign but they don’t seem very benign to me. They cause severe hypertension and great stress on the body and should be diagnosed as soon as possible. Blood pressure can easily hit 250/150 during an episode or provocation.
Appropriate routine screening coupled with a reasonable level of suspicion by the doctors should allow most to be found. Certainly a host of accurate readings taken by the patient would be most helpful. See how and why at How To Take Blood Pressure Some clues are severity of BP elevation, youth, episodic occurrence, above listed symptoms and hyperkinetic state.
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