August 24, 2016
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Pheochromocytoma (cont.)

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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 other types of endocrine tumors, including 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.

Medically Reviewed by a Doctor on 3/27/2015



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