0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18
1166 Pheochromocytoma■Unusual BP response to surgery, anesthesia, or trauma
■Family history of pheochromocytoma, adrenal tumor, medullary
carcinoma of the thyroid, hypercalcemia/hyperparathyroidism
■Genetic associations: neurofibromatosis, Von-Hippel Landau dis-
ease, multiple endocrine neoplasia (MEN) II
■Medications: antihypertensives, decongestants, stimulants, adren-
ergic bronchodilators, MAO inhibitors, labetolol and buspirone
(interfere with catecholamine tests), clonidine or beta-blocker with-
drawal
■Diabetes, constipation
■Psychiatric disorders, alcohol or illicit drug use, spinal cord injury
■History of angina, MI, CVA
Signs & Symptoms
■Episodic headache, sweating, and palpitations
■Orthostatic hypotension, chest pain, abdominal pain
■Blurred vision, weight loss, polyuria, polydipsia
■Constipation, anxiety, “spells” or panic attacks
■Labile or difficult to control hypertension
■Orthostatic hypotension (due to volume contraction)
■Lid lag, papilledema
■Neurocutaneous disease
■Pallor (due to vasoconstriction)
■Abdominal mass, dilated cardiomyopathy
■Cutaneous flushing
■Thyroid nodule or mucosal/eyelid neuromas (in association in MEN
IIA or IIB)
tests
■Basic Tests
➣24-h urine collection for fractionated urinary metanephrines
(metanephrine and normetanephrine), free catecholamines
(norepinephrine and epinephrine); creatinine (to ensure com-
plete collection of urine)
■Confirmatory Tests
➣Plasma catecholamines; perform in resting conditions with
indwelling catheter after 30 min of rest, avoid setting of acute
illness
➣Clonidine suppression test: plasma catecholamines before and
3 h after oral clonidine.
➣Plasma chromogranin
➣Plasma calcitonin: for MEN-2