Pheochromocytoma

Background

• Pheochromocytoma is a rare tumor arising from chromaffin cells in adrenal medulla or other paraganglia in the body.
• Pheochromocytomas cause increased catecholamine production leading to its clinical manifestations.

Clinical Features

• headache
• alternating periods of normal and elevated blood pressure. Can cause resistant hypertension and hypertensive emergency.
• tachycardia
• flushed skin
• palpitations
• diaphoresis
• weight loss

Differential Diagnosis

• hypertensive crisis
• sympathomimetic drug use (cocaine, amphetamine, PCP)
• withdrawal from alcohol, benzodiazepines, or narcotics
• serotonin syndrome
• autonomic neuropathy
• porphyria

Diagnosis

• plasma free metanephrines or urinary fractionated metanephrines
• CT imaging to localize tumor
• general lab features include hyperglycemia, hypercalcemia, and erythrocytosis

Management

• alpha blockade with phenoxybenzamine or phentolamine acutely
• beta blockade can be started 2 days later
• eventual surgical resection of tumor

Disposition

• admission to a monitored setting

References

• 1. Garg, M., Brar, K., Mittal, R., Kharb, S., & Gundgurthi, A. (2011). Medical management of pheochromocytoma: Role of the endocrinologist. Indian Journal Of Endocrinology And Metabolism, 15(8), 329. http://dx.doi.org/10.4103/2230-8210.86976
• 2. 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.)
• 3. DM Cline, AJ Machado (2015). "Systemic and Pulmonary Hypertension." Tintinalli's Emergency Medicine. Mcgraw-Hill Education.
• 4. Pheochromocytoma. (n.d.). In Wikipedia. Retrieved January 11, 2016, from http://en.wikipedia.org/wiki/pheochromocytoma