Presentations are variable and can include:
- headaches
- visual disturbances
- chest tightness
- palpitations
- hypertension (70% persistent, 30% episodic)
- hypotension/postural hypotension is also possible
- faints
- abdominal pain
The triad of headache, sweating and palpitations is 90% predictive.
Lots of facts to remember about phaeochromocytomas follow the rule of 10%:
10% are familial (= MEN II, neurofibrosis, Von Hippel Lindau)
10% are bilateral, 10% are malignant and10% are extraadrenal
The commonest extraadrenal site is the organ of Zuckerkandl, which is adjacent to the bifurcation of the aorta.
Diagnosis is by VMA in urine and CT/MRI (show up bright white on T2 weighted MRI)
Treatment is surgery with pre-op alpha and beta blockade (alpha blocker of choice = phenoxybenzamine)
Recurrence is possible so these patients should be followed up lifelong.
Thats all for today, hopefully more tomorrow!
