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{{Incidentaloma}}
{{Incidentaloma}}
{{CMG}}; {{AE}} {{MAD}}


{{CMG}}; {{AE}}  
==Overview==
Most of patients will not show any special signs as the definition of [[Adrenal gland|adrenal]] incidentaloma means incidentaly discovered [[mass]] during imaging for ant other reasons. Some cases show signs of [[subclinical]] [[Cushing's syndrome]], [[Pheochromocytoma|pheochromocytoma,]] or [[hyperaldosteronism]]. Common physical examination findings of include patients may appear quite well if the [[disease]] is [[asymptomatic]]. Patients may appear tired, weak, [[diaphoretic]] and [[anxious]]. [[Tachypnea]] if [[malignant]] secondaries are found in the [[lung]] with a rapid strong equal [[pulse]] and high [[blood pressure]]. [[Jaundice]], [[Hyperpigmentation|hyperpigmentation,]] [[Telangiectasia]], thinning of the skin and easy bruising may be found. A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant may be found. [[Hyporeflexia]] due to low [[potassium]] level in [[Hyperaldosteronism|aldosternonma]], [[Proximal]] [[muscle weakness]] bilaterally, and bilateral [[tremors]] may be found.
 
== Incidentaloma physical examination ==
Physical examination of incidentaloma is dependent on the underlying cause and the nature of the lesion in the [[adrenal glands]]. Some cases may show signs of [[subclinical]] [[Cushing's syndrome]], [[Pheochromocytoma|pheochromocytoma,]] or [[hyperaldosteronism]].
 
===Physical Examination of subclinical Cushing's syndrome===
Physical examination of patients with subclinical [[Cushing's syndrome]] is as follows:<ref name="pmid26156970">{{cite journal |vauthors=Nieman LK |title=Cushing's syndrome: update on signs, symptoms and biochemical screening |journal=Eur. J. Endocrinol. |volume=173 |issue=4 |pages=M33–8 |year=2015 |pmid=26156970 |pmc=4553096 |doi=10.1530/EJE-15-0464 |url=}}</ref>
===Appearance of the patient===
*Patients with Cushing's syndrome usually appears [[overweight]].


==Overview==
===Vital signs===
Common physical examination findings of include
==Physical Examination==


===Appearance of the Patient===
* [[Hypertension]], due to [[Cortisol|cortisol's]] enhancement of [[epinephrine]]'s [[vasoconstrictive]] effect.
* Patients may appear tired, weak, [[diaphoretic]] and [[anxious]].<sup>[[Pheochromocytoma physical examination#cite note-pmid8325290-1|[1]]]</sup>
* Patients may appear quite well if the [[disease]] is [[asymptomatic]].
* Patients may appear [[Flushing|flushed]] due to associated increase in [[erythropoietin]] secretion.<sup>[[Pheochromocytoma physical examination#cite note-pmid7567437-2|[2]]]</sup>
* Patients may appear [[obese]] due to associated type2 [[diabetes mellitus]] and [[Cushing's syndrome]].<sup>[[Pheochromocytoma physical examination#cite note-pmid12923403-3|[3]]]</sup>
* Patients with Cushing's syndrome usually appears [[overweight]].


===Vital Signs===
===Head===
* [[Tachycardia]] with a regular pulse. Irregular pulse may occurr in [[supraventricular tachycardia]].
*[[Moon face|Moon-face]] is a medical sign where the face swells up into a rounded shape. It is often associated with [[Cushing's syndrome]], which has led to it being known as Cushingoid facies ("Cushings-like face"), or [[steroid]] treatment, which has led to the name steroid facies.
* [[Tachypnea]] if [[malignant]] secondaries are found in the [[lung]]. [[Dyspnea]] occurs in patients with complicated [[heart failure]] and [[Cardiomyopathy|cardiomyopathy.]]
* Rapid strong equal [[pulse]]
* High [[blood pressure]] with normal [[pulse pressure]]
* [[Hypotension]] occurs due to fluid contraction
* [[Hypertension]], due to [[Cortisol|cortisol's]] enhancement of [[epinephrine]]'s [[vasoconstrictive]] effect


===Skin===
===Skin===
* [[Jaundice]] secondary to deranged [[liver]] function in case of [[metastasis]] to the [[liver]].
* [[Hyperpigmentation]] - this is due to [[melanocyte-stimulating hormone]] production as a byproduct of [[Adrenocorticotropic hormone|ACTH]] synthesis from [[Proopiomelanocortin|Proopiomelanocortin (POMC)]]
* [[Hyperpigmentation]] - this is due to Melanocyte-Stimulating Hormone production as a byproduct of ACTH synthesis from [[Proopiomelanocortin|Proopiomelanocortin (POMC)]]
* [[Telangiectasia]] (dilation of [[Capillary|capillaries]])
* [[Telangiectasia]] (dilation of capillaries)
* Thinning of the skin (which causes [[easy bruising]])
* Thinning of the skin (which causes [[easy bruising]])
* Purple or red [[striae]] (the weight gain in Cushing's stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness (hips, shoulders)
* Purple or red [[striae]] (the weight gain in Cushing's stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness (hips, shoulders)
* [[Hirsutism]] (facial male-pattern hair growth)
* [[Hirsutism]] (facial male-pattern hair growth)


===HEENT===
===Eye===
* [[Facial flushing]]
* [[Bitemporal hemianopsia]] - [[Pituitary gland|pituitary]] lesion may compress the [[optic chiasm]]
* [[Icterus|Scleral icterus]] in case of [[metastasis]] to the [[liver]]
* [[MEN2]] patients associated with [[mucosal]] [[Neuroma|neuromas]] show multiple lips and tongue [[Neuroma|neuromas]].
* [[Moon face|Moon-face]] is a medical sign where the face swells up into a rounded shape. It is often associated with [[Cushing's syndrome]], which has led to it being known as Cushingoid facies ("Cushings-like face"), or [[steroid]] treatment, which has led to the name steroid facies.


===Neck===
===Neck===
* Congested [[neck veins]] in patients with [[cardiomyopathy]]<sup>[[Pheochromocytoma physical examination#cite note-pmid19158054-4|[4]]]</sup>
* Growth of fat pads along the collar bone and on the back of the neck (known as a [[lipodystrophy]])
* Painless [[lymphadenopathy]] if [[malignant]] secondaries found in the neck (rapid increase in the size of the [[Lymph node|node]]. [[Prevalence]] of [[malignancy]] in [[Lymph node biopsy|lymph node biopsies]] performed is 60%<sup>[[Pheochromocytoma physical examination#cite note-pmid18888946-5|[5]]]</sup>
[[Image:Cushings-syndrome.jpg|thumb|center|Features of Cushing's syndrome(Image courtesy of Jessica Stevenson, and http://www.physio-pedia.com/File:Cushings-syndrome2.jpg#filelinks)|325px]]
* [[Thyromegaly]]/[[thyroid]] [[nodules]] if [[Multiple endocrine neoplasia|MEN]] patients due to [[medullary thyroid cancer]].<sup>[[Pheochromocytoma physical examination#cite note-pmid258100472-6|[6]]]</sup>
 
* Growth of fat pads along the collar bone and on the back of the neck.
===Physical Examination of pheochromocytoma===
 
=== Appearance of the Patient ===
* Patients may appear tired, weak, [[diaphoretic]] and [[anxious]].<ref name="pmid8325290">{{cite journal| author=Bravo EL, Gifford RW| title=Pheochromocytoma. | journal=Endocrinol Metab Clin North Am | year= 1993 | volume= 22 | issue= 2 | pages= 329-41 | pmid=8325290 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8325290  }}</ref>  
* Patients may appear quite well if the [[disease]] is [[asymptomatic]].
* Patients may appear [[Flushing|flushed]] due to associated increase in [[erythropoietin]] secretion.<ref name="pmid7567437">{{cite journal| author=Drénou B, Le Tulzo Y, Caulet-Maugendre S, Le Guerrier A, Leclercq C, Guilhem I et al.| title=Pheochromocytoma and secondary erythrocytosis: role of tumour erythropoietin secretion. | journal=Nouv Rev Fr Hematol | year= 1995 | volume= 37 | issue= 3 | pages= 197-9 | pmid=7567437 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7567437  }}</ref>
* Patients may appear [[obese]] due to associated type2 [[diabetes mellitus]] and [[Cushing's syndrome]].<ref name="pmid12923403">{{cite journal| author=La Batide-Alanore A, Chatellier G, Plouin PF| title=Diabetes as a marker of pheochromocytoma in hypertensive patients. | journal=J Hypertens | year= 2003 | volume= 21 | issue= 9 | pages= 1703-7 | pmid=12923403 | doi=10.1097/01.hjh.0000084729.53355.ce | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12923403  }}</ref>
 
=== Vital Signs ===
* [[Tachycardia]] with a regular pulse. Irregular pulse may occurr in [[supraventricular tachycardia]].
* [[Tachypnea]] if [[malignant]] secondaries are found in the [[lung]]. [[Dyspnea]] occurs in patients with complicated [[heart failure]] and [[Cardiomyopathy|cardiomyopathy.]]
* Rapid strong equal [[pulse]].
* High [[blood pressure]] with normal [[pulse pressure]].
* [[Hypotension]] occurs due to fluid contraction.
 
=== Skin ===
* [[Jaundice]] secondary to deranged [[liver]] function in case of [[metastasis]] to the [[liver]].
 
=== Head ===
* [[Facial flushing]].
* [[Icterus|Scleral icterus]] in case of [[metastasis]] to the [[liver]].
* [[MEN2]] patients associated with [[mucosal]] [[Neuroma|neuromas]] show multiple lips and tongue [[Neuroma|neuromas]].
 
=== Neck ===
* Congested [[neck veins]] in patients with [[cardiomyopathy|cardiomyopathy.]]<ref name="pmid19158054">{{cite journal| author=Kassim TA, Clarke DD, Mai VQ, Clyde PW, Mohamed Shakir KM| title=Catecholamine-induced cardiomyopathy. | journal=Endocr Pract | year= 2008 | volume= 14 | issue= 9 | pages= 1137-49 | pmid=19158054 | doi=10.4158/EP.14.9.1137 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19158054  }}</ref>
 
* Painless [[lymphadenopathy]] if [[malignant]] secondaries found in the neck (rapid increase in the size of the [[Lymph node|node]]. [[Prevalence]] of [[malignancy]] in [[Lymph node biopsy|lymph node biopsies]] performed is 60%.<ref name="pmid18888946">{{cite journal| author=HEINRICH WA, JUDD ES| title=A critical analysis of biopsy of lymph nodes. | journal=Proc Staff Meet Mayo Clin | year= 1948 | volume= 23 | issue= 21 | pages= 465-9 | pmid=18888946 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18888946  }}</ref>
* [[Thyromegaly]]/[[thyroid]] [[nodules]] if [[Multiple endocrine neoplasia|MEN]] patients due to [[medullary thyroid cancer]].<ref name="pmid258100472">{{cite journal| author=Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF et al.| title=Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. | journal=Thyroid | year= 2015 | volume= 25 | issue= 6 | pages= 567-610 | pmid=25810047 | doi=10.1089/thy.2014.0335 | pmc=4490627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25810047  }}</ref>
 
=== Lungs ===
* Asymmetric [[chest]] expansion / decreased [[chest]] expansion if [[malignant]] secondaries are found in the [[lung]].
 
=== Heart ===
* Chest [[tenderness]] upon [[palpation]] in [[MEN1]] patients due to [[hyperparathyroidism]].
* [[Palpation]]: [[Precordium|Precordial]] [[heave]] especially at apex due to [[left ventricular hypertrophy]] in long standing patients.
* Auscultation: normal [[Heart sounds|S1]] and accentuated [[Heart sounds|S2]] due to high systemic resistance.
 
=== Abdomen ===
* [[Abdominal distention]] in patients with [[primary hyperparathyroidism]] associated [[constipation]] or [[Hirschsprung's disease|Hirschsprung disease]].
* [[Abdominal tenderness]] in the lower [[abdominal]] quadrants in [[Multiple endocrine neoplasia type 2|MEN2]] patients with [[Hirschsprung disease|Hirschsprung disease.]]<ref name="pmid7491537">{{cite journal| author=O'Riordain DS, O'Brien T, Crotty TB, Gharib H, Grant CS, van Heerden JA| title=Multiple endocrine neoplasia type 2B: more than an endocrine disorder. | journal=Surgery | year= 1995 | volume= 118 | issue= 6 | pages= 936-42 | pmid=7491537 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7491537  }}</ref>
* A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant.
* [[Abdominal guarding|Guarding]] may be present.
* [[Hepatomegaly]] if [[malignant]] secondaries found in [[liver]].
* [[Diarrhea]] caused by [[gastrointestinal]] secretion of fluid and [[Electrolyte|electrolytes]], and [[flushing]] in [[medullary thyroid cancer]] patients.<ref name="pmid25810047">{{cite journal| author=Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF et al.| title=Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. | journal=Thyroid | year= 2015 | volume= 25 | issue= 6 | pages= 567-610 | pmid=25810047 | doi=10.1089/thy.2014.0335 | pmc=4490627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25810047  }}</ref>
 
=== Back ===
* Point [[tenderness]] in [[MEN1]] patients with [[hyperparathyroidism]].
 
=== Physical Examination of hyperaldosteronism ===
 
==== Appearance of the patient ====
* Patient is usually well-appearing
 
=== Vital signs ===
* Normal body temperature
* [[Tachycardia]] with [[irregular pulse]]<ref name="pmid19946238">{{cite journal |vauthors=Zelinka T, Holaj R, Petrák O, Strauch B, Kasalický M, Hanus T, Melenovský V, Vancura V, Bürgelová M, Widimský J |title=Life-threatening arrhythmia caused by primary aldosteronism |journal=Med. Sci. Monit. |volume=15 |issue=12 |pages=CS174–7 |year=2009 |pmid=19946238 |doi= |url=}}</ref><ref name="pmid11045185">{{cite journal |vauthors=Pella J, Lazúrová I, Javorská B, Trejbal D |title=[Conn's syndrome and severe arrhythmias] |language=Slovak |journal=Vnitr Lek |volume=45 |issue=4 |pages=228–31 |year=1999 |pmid=11045185 |doi= |url=}}</ref>
* Normal respiratory rate
* High [[blood pressure]] may be the only presenting sign
 
=== Skin ===
* There are no abnormal skin findings associated with primary hyperaldosteronism
 
=== HEENT ===
* HEENT examination is normal in primary hyperaldosteronism.
 
=== Neck ===
* No [[lymphadenopathy]]
* No [[thyromegaly]]
 
* Elevated [[Jugular venous pressure|JVP]]
 
=== Lungs ===
* Symmetric chest expansion
* Normal breath sounds
* No [[rales]], rhochi and [[wheeze]]
* [[Egophony]] absent
* [[Bronchophony]] absent
* Normal [[tactile fremitus]]


===Lungs===
=== Heart ===
* Asymmetric [[chest]] expansion / decreased [[chest]] expansion if [[malignant]] secondaries are found in the [[lung]].
* No chest tenderness on palpation
* PMI within 2 cm of the sternum
* [[Heart sounds#First heart tone S1.2C the .22lub.22.28components M1 and T1.29|S1]]
* [[Heart sounds#Second heart tone S2 the .22dub.22.28components A2 and P2.29|S2]]
* [[Heart sounds#Fourth heart sound S4|S4]] may be heard due to [[left ventricular hypertrophy]]<ref name="pmid15291171">{{cite journal |vauthors=du Cailar G |title=[Cardiac consequences of primary hyperaldosteronism] |language=French |journal=Ann Cardiol Angeiol (Paris) |volume=53 |issue=3 |pages=147–9 |year=2004 |pmid=15291171 |doi= |url= |issn=}}</ref>
* No [[gallop rhythm]]
* [[Ventricular fibrillation]] may be a finding in primary hyperaldosteronism<ref name="pmid19610566">{{cite journal |vauthors=Delgado Y, Quesada E, Pérez Arzola M, Bredy R |title=Ventricular fibrillation as the first manifestation of primary hyperaldosteronism |journal=Bol Asoc Med P R |volume=98 |issue=4 |pages=258–62 |year=2006 |pmid=19610566 |doi= |url= |issn=}}</ref>


===Heart===
=== Abdomen ===
* Chest [[tenderness]] upon [[palpation]] in [[MEN1]] patients due to [[hyperparathyroidism]].
* Non-tender
* [[Palpation]]: [[Precordium|Precordial]] [[heave]] especially at apex due to [[left ventricular hypertrophy]] in long standing patients.
* Non-distended
* Auscultation: normal [[Heart sounds|S1]] and accentuated [[Heart sounds|S2]] due to high systemic resistance.
* No abnormal fluids or gas
* No palpable [[organomegaly]]


===Abdomen===
=== Back ===
* [[Abdominal distention]] in patients with [[primary hyperparathyroidism]] associated [[constipation]] or [[Hirschsprung's disease|Hirschsprung disease]].
* There are no abnormal findings on the back associated with primary hyperaldosteronism.
* [[Abdominal tenderness]] in the lower [[abdominal]] quadrants in [[Multiple endocrine neoplasia type 2|MEN2]] patients with [[Hirschsprung disease|Hirschsprung disease.]]<sup>[[Pheochromocytoma physical examination#cite note-pmid7491537-7|[7]]]</sup>
* A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant.
* [[Abdominal guarding|Guarding]] may be present.
* [[Hepatomegaly]] if [[malignant]] secondaries found in [[liver]].
* [[Diarrhea]] caused by [[gastrointestinal]] secretion of fluid and [[Electrolyte|electrolytes]], and [[flushing]] in [[medullary thyroid cancer]] patients.<sup>[[Pheochromocytoma physical examination#cite note-pmid25810047-8|[8]]]</sup>


===Back ===
=== Genitourinary ===
* Point [[tenderness]] in [[MEN1]] patients with [[hyperparathyroidism]]
* There are no abnormal [[Genitourinary system|genitourinary]] findings  associated with primary hyperaldosteronism


===Neuromuscular===
=== Extremities ===
* [[Hyporeflexia]] due to low [[potassium]] level in [[Hyperaldosteronism|aldosternonma]]
* Extremities are normal on examination in primary hyperaldosteronism
* [[Proximal]] [[muscle weakness]] bilaterally
*Bilateral [[tremors]]


===Extremities===
=== Neurologic ===
*[[Clubbing]]  
* Hyperaldosteronism induced [[hypertension]] may lead to [[stroke]] and [[paralysis]]<ref name="pmid10023636">{{cite journal |vauthors=Nishimura M, Uzu T, Fujii T, Kuroda S, Nakamura S, Inenaga T, Kimura G |title=Cardiovascular complications in patients with primary aldosteronism |journal=Am. J. Kidney Dis. |volume=33 |issue=2 |pages=261–6 |year=1999 |pmid=10023636 |doi= |url= |issn=}}</ref>
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*[[Muscle atrophy]]
*[[Fasciculations]] in the upper/lower extremity


==References==
==References==

Latest revision as of 18:38, 7 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Overview

Most of patients will not show any special signs as the definition of adrenal incidentaloma means incidentaly discovered mass during imaging for ant other reasons. Some cases show signs of subclinical Cushing's syndrome, pheochromocytoma, or hyperaldosteronism. Common physical examination findings of include patients may appear quite well if the disease is asymptomatic. Patients may appear tired, weak, diaphoretic and anxious. Tachypnea if malignant secondaries are found in the lung with a rapid strong equal pulse and high blood pressure. Jaundice, hyperpigmentation, Telangiectasia, thinning of the skin and easy bruising may be found. A palpable abdominal mass in the lower abdominal quadrant may be found. Hyporeflexia due to low potassium level in aldosternonma, Proximal muscle weakness bilaterally, and bilateral tremors may be found.

Incidentaloma physical examination

Physical examination of incidentaloma is dependent on the underlying cause and the nature of the lesion in the adrenal glands. Some cases may show signs of subclinical Cushing's syndrome, pheochromocytoma, or hyperaldosteronism.

Physical Examination of subclinical Cushing's syndrome

Physical examination of patients with subclinical Cushing's syndrome is as follows:[1]

Appearance of the patient

  • Patients with Cushing's syndrome usually appears overweight.

Vital signs

Head

  • Moon-face is a medical sign where the face swells up into a rounded shape. It is often associated with Cushing's syndrome, which has led to it being known as Cushingoid facies ("Cushings-like face"), or steroid treatment, which has led to the name steroid facies.

Skin

Eye

Neck

  • Growth of fat pads along the collar bone and on the back of the neck (known as a lipodystrophy)
Features of Cushing's syndrome(Image courtesy of Jessica Stevenson, and http://www.physio-pedia.com/File:Cushings-syndrome2.jpg#filelinks)

Physical Examination of pheochromocytoma

Appearance of the Patient

Vital Signs

Skin

Head

Neck

Lungs

Heart

Abdomen

Back

Physical Examination of hyperaldosteronism

Appearance of the patient

  • Patient is usually well-appearing

Vital signs

Skin

  • There are no abnormal skin findings associated with primary hyperaldosteronism

HEENT

  • HEENT examination is normal in primary hyperaldosteronism.

Neck

Lungs

Heart

Abdomen

  • Non-tender
  • Non-distended
  • No abnormal fluids or gas
  • No palpable organomegaly

Back

  • There are no abnormal findings on the back associated with primary hyperaldosteronism.

Genitourinary

  • There are no abnormal genitourinary findings associated with primary hyperaldosteronism

Extremities

  • Extremities are normal on examination in primary hyperaldosteronism

Neurologic

References

  1. ↑ Nieman LK (2015). "Cushing's syndrome: update on signs, symptoms and biochemical screening". Eur. J. Endocrinol. 173 (4): M33–8. doi:10.1530/EJE-15-0464. PMC 4553096. PMID 26156970.
  2. ↑ Bravo EL, Gifford RW (1993). "Pheochromocytoma". Endocrinol Metab Clin North Am. 22 (2): 329–41. PMID 8325290.
  3. ↑ Drénou B, Le Tulzo Y, Caulet-Maugendre S, Le Guerrier A, Leclercq C, Guilhem I; et al. (1995). "Pheochromocytoma and secondary erythrocytosis: role of tumour erythropoietin secretion". Nouv Rev Fr Hematol. 37 (3): 197–9. PMID 7567437.
  4. ↑ La Batide-Alanore A, Chatellier G, Plouin PF (2003). "Diabetes as a marker of pheochromocytoma in hypertensive patients". J Hypertens. 21 (9): 1703–7. doi:10.1097/01.hjh.0000084729.53355.ce. PMID 12923403.
  5. ↑ Kassim TA, Clarke DD, Mai VQ, Clyde PW, Mohamed Shakir KM (2008). "Catecholamine-induced cardiomyopathy". Endocr Pract. 14 (9): 1137–49. doi:10.4158/EP.14.9.1137. PMID 19158054.
  6. ↑ HEINRICH WA, JUDD ES (1948). "A critical analysis of biopsy of lymph nodes". Proc Staff Meet Mayo Clin. 23 (21): 465–9. PMID 18888946.
  7. ↑ Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF; et al. (2015). "Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma". Thyroid. 25 (6): 567–610. doi:10.1089/thy.2014.0335. PMC 4490627. PMID 25810047.
  8. ↑ O'Riordain DS, O'Brien T, Crotty TB, Gharib H, Grant CS, van Heerden JA (1995). "Multiple endocrine neoplasia type 2B: more than an endocrine disorder". Surgery. 118 (6): 936–42. PMID 7491537.
  9. ↑ Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF; et al. (2015). "Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma". Thyroid. 25 (6): 567–610. doi:10.1089/thy.2014.0335. PMC 4490627. PMID 25810047.
  10. ↑ Zelinka T, Holaj R, Petrák O, Strauch B, Kasalický M, Hanus T, Melenovský V, Vancura V, Bürgelová M, Widimský J (2009). "Life-threatening arrhythmia caused by primary aldosteronism". Med. Sci. Monit. 15 (12): CS174–7. PMID 19946238.
  11. ↑ Pella J, Lazúrová I, Javorská B, Trejbal D (1999). "[Conn's syndrome and severe arrhythmias]". Vnitr Lek (in Slovak). 45 (4): 228–31. PMID 11045185.
  12. ↑ du Cailar G (2004). "[Cardiac consequences of primary hyperaldosteronism]". Ann Cardiol Angeiol (Paris) (in French). 53 (3): 147–9. PMID 15291171.
  13. ↑ Delgado Y, Quesada E, Pérez Arzola M, Bredy R (2006). "Ventricular fibrillation as the first manifestation of primary hyperaldosteronism". Bol Asoc Med P R. 98 (4): 258–62. PMID 19610566.
  14. ↑ Nishimura M, Uzu T, Fujii T, Kuroda S, Nakamura S, Inenaga T, Kimura G (1999). "Cardiovascular complications in patients with primary aldosteronism". Am. J. Kidney Dis. 33 (2): 261–6. PMID 10023636.

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