Pheochromocytoma differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 64: | Line 64: | ||
* Fear precedes physical symptoms. | * Fear precedes physical symptoms. | ||
| | | | ||
* Patients look anxious with tired attitude. | |||
* [[Tachycardia]] | |||
* [[Hypertension]] | |||
* [[Sweating]] | |||
| | | | ||
Laboratory studies that can exclude medical disorders other than [[panic disorder]] include: | Laboratory studies that can exclude medical disorders other than [[panic disorder]] include: | ||
| Line 73: | Line 77: | ||
|Labile hypertension ([[White coat hypertension]]) | |Labile hypertension ([[White coat hypertension]]) | ||
| | | | ||
* Elevated [[blood pressure]] in a clinical setting but not in other settings<sup>[[Chronic hypertension differential diagnosis#cite note-pmid24107724-1|[1]]]</sup> | * No history of [[hypertension]] | ||
|Elevated [[blood pressure]], [[tachycardia]], and may be [[anxiety]] in a clinical setting but not in other settings<sup>[[Chronic hypertension differential diagnosis#cite note-pmid24107724-1|[1]]]</sup> | |||
| | | | ||
* Ambulatory blood pressure monitoring and patient self-measurement using a home [[blood pressure]] monitoring device are being increasingly used to differentiate patients with [[white coat hypertension]] from patients with true [[hypertension]]. | * Ambulatory blood pressure monitoring and patient self-measurement using a home [[blood pressure]] monitoring device are being increasingly used to differentiate patients with [[white coat hypertension]] from patients with true [[hypertension]]. | ||
| Line 140: | Line 144: | ||
** Few seconds of staring into space | ** Few seconds of staring into space | ||
| | | | ||
* Physical examination is important when [[central nervous system infection]] or hemorrhage are diagnostic possibilities | |||
* A tongue bite or laceration in [[Tonic-clonic seizure|generalized tonic-clonic seizure]]<ref name="pmid23041172">{{cite journal|author=Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG et al.|title=Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective.|journal=Epilepsy Behav|year=2012|volume=25|issue=2|pages=251-5|pmid=23041172|doi=10.1016/j.yebeh.2012.06.020|pmc=|url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23041172}}</ref> | |||
| | | | ||
* Abnormal [[electroencephalography]] | * Abnormal [[electroencephalography]]: a positive test without a clinical presentation is called a [[Subclinical seizure|sub-clinical seizure]].<ref name="pmid21205698">{{cite journal|author=Fountain NB, Van Ness PC, Swain-Eng R, Tonn S, Bever CT, American Academy of Neurology Epilepsy Measure Development Panel and the American Medical Association-Convened Physician Consortium for Performance Improvement Independent Measure Development Process|title=Quality improvement in neurology: AAN epilepsy quality measures: Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology.|journal=Neurology|year=2011|volume=76|issue=1|pages=94-9|pmid=21205698|doi=10.1212/WNL.0b013e318203e9d1|pmc=|url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21205698}}</ref> | ||
* [[Lumbar puncture]] is useful to exclude acute [[central nervous system infections]]. | |||
* A neuroimaging study should be performed in all adults with a first seizure to evaluate structural brain abnormalities. [[Magnetic resonance imaging]] is preferred over [[computed tomography]]. | |||
|- | |- | ||
|[[Carcinoid syndrome]] | |[[Carcinoid syndrome]] | ||
Revision as of 14:26, 18 August 2017
|
Pheochromocytoma Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Pheochromocytoma differential diagnosis On the Web |
|
American Roentgen Ray Society Images of Pheochromocytoma differential diagnosis |
|
Risk calculators and risk factors for Pheochromocytoma differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2] Mohammed Abdelwahed M.D[3]
Overview
Pheochromocytoma must be differentiated from other causes of paroxysmal hypertension including severe paroxysmal hypertension (pseudopheochromocytoma), panic disorder, factitious hypertension, carcinoid syndrome, migraine headache, hyperthyroidism, renovascular hypertension, hypoglycemia, labile hypertension (White coat hypertension), stroke, compression of the lateral medulla, seizures, baroreflex failure and drugs.
Differentiating pheochromocytoma from other diseases
Pheochromocytoma must be differentiated from other causes of paroxysmal hypertension. The differentials include:
| Disease | Symptoms | Signs | Investigations |
|---|---|---|---|
| Pheochromocytoma | The symptoms of a pheochromocytoma are those of sympathetic nervous systemhyperactivity and include:[1]
|
|
|
| Pseudopheochromocytoma[1][2][3][4] | Paroxysmal activation of the sympathetic system causing:
|
| |
| Panic attacks |
|
|
Laboratory studies that can exclude medical disorders other than panic disorder include: |
| Labile hypertension (White coat hypertension) |
|
Elevated blood pressure, tachycardia, and may be anxiety in a clinical setting but not in other settings[1] |
|
| Hyperthyroidism |
|
|
|
| Renovascular hypertension |
|
| |
| Stroke and compression of lateral medulla (Lateral medullary syndrome) | Extensive unilateral infarction of the brain stem in the region of the nucleus tractus solitarius may result in partial baroreflex dysfunction, increased sympathetic activity, and neurogenic paroxysmal hypertension |
| |
| Seizures | According to type; it may be focal or generalized, clinical or subclinical:[7]
|
|
|
| Carcinoid syndrome | Hypertensive crisis occurs with malignant carcinoid syndrome[10]. Symptoms include:
|
| |
| Migraine headaches |
|
|
CT is indicated in patients with:[1][2]
CT is not indicated in:
|
| Drugs | Sympathomimetic drugs that can induce symptoms simulating pheochromocytoma include:
|
|
|
| Baroreflex failure |
|
|
References
- ↑ Mann SJ (1999). "Severe paroxysmal hypertension (pseudopheochromocytoma): understanding the cause and treatment". Arch Intern Med. 159 (7): 670–4. PMID 10218745.
- ↑ Mann SJ (1999). "Severe paroxysmal hypertension (pseudopheochromocytoma): understanding the cause and treatment". Arch Intern Med. 159 (7): 670–4. PMID 10218745.
- ↑ Mann SJ (1996). "Severe paroxysmal hypertension. An automatic syndrome and its relationship to repressed emotions". Psychosomatics. 37 (5): 444–50. doi:10.1016/S0033-3182(96)71532-3. PMID 8824124.
- ↑ Sharabi Y, Goldstein DS, Bentho O, Saleem A, Pechnik S, Geraci MF; et al. (2007). "Sympathoadrenal function in patients with paroxysmal hypertension: pseudopheochromocytoma". J Hypertens. 25 (11): 2286–95. doi:10.1097/HJH.0b013e3282ef5fac. PMID 17921824.
- ↑ Iglesias P, Acosta M, Sánchez R, Fernández-Reyes MJ, Mon C, Díez JJ (2005). "Ambulatory blood pressure monitoring in patients with hyperthyroidism before and after control of thyroid function". Clin Endocrinol (Oxf). 63 (1): 66–72. doi:10.1111/j.1365-2265.2005.02301.x. PMID 15963064.
- ↑ Mintz G, Pizzarello R, Klein I (1991). "Enhanced left ventricular diastolic function in hyperthyroidism: noninvasive assessment and response to treatment". J Clin Endocrinol Metab. 73 (1): 146–50. doi:10.1210/jcem-73-1-146. PMID 2045465.
- ↑ 7.0 7.1 Mintz G, Pizzarello R, Klein I (1991). "Enhanced left ventricular diastolic function in hyperthyroidism: noninvasive assessment and response to treatment". J Clin Endocrinol Metab. 73 (1): 146–50. doi:10.1210/jcem-73-1-146. PMID 2045465.
- ↑ Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG; et al. (2012). "Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective". Epilepsy Behav. 25 (2): 251–5. doi:10.1016/j.yebeh.2012.06.020. PMID 23041172.
- ↑ Fountain NB, Van Ness PC, Swain-Eng R, Tonn S, Bever CT, American Academy of Neurology Epilepsy Measure Development Panel and the American Medical Association-Convened Physician Consortium for Performance Improvement Independent Measure Development Process (2011). "Quality improvement in neurology: AAN epilepsy quality measures: Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology". Neurology. 76 (1): 94–9. doi:10.1212/WNL.0b013e318203e9d1. PMID 21205698.
- ↑ Warner RR, Mani S, Profeta J, Grunstein E (1994). "Octreotide treatment of carcinoid hypertensive crisis". Mt Sinai J Med. 61 (4): 349–55. PMID 7969229.
- ↑ Sjöblom SM (1988). "Clinical presentation and prognosis of gastrointestinal carcinoid tumours". Scand J Gastroenterol. 23 (7): 779–87. PMID 3227292.
- ↑ Feldman JM (1986). "Urinary serotonin in the diagnosis of carcinoid tumors". Clin Chem. 32 (5): 840–4. PMID 2421946.
- ↑ Eriksson B, Arnberg H, Oberg K, Hellman U, Lundqvist G, Wernstedt C; et al. (1990). "A polyclonal antiserum against chromogranin A and B--a new sensitive marker for neuroendocrine tumours". Acta Endocrinol (Copenh). 122 (2): 145–55. PMID 2316306.
- ↑ Sundin A, Vullierme MP, Kaltsas G, Plöckinger U, Mallorca Consensus Conference participants. European Neuroendocrine Tumor Society (2009). "ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: radiological examinations". Neuroendocrinology. 90 (2): 167–83. doi:10.1159/000184855. PMID 19077417.
- ↑ Kelman L (2004). "The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs". Headache. 44 (9): 865–72. doi:10.1111/j.1526-4610.2004.04168.x. PMID 15447695.
- ↑ Krentz AJ, Mikhail S, Cantrell P, Hill GM (2001). "Drug Points: Pseudophaeochromocytoma syndrome associated with clozapine". BMJ. 322 (7296): 1213. PMC 31620. PMID 11358774.
- ↑ Kuchel O (1985). "Pseudopheochromocytoma". Hypertension. 7 (1): 151–8. PMID 3980057.
- ↑ 18.0 18.1 Zar T, Peixoto AJ (2008). "Paroxysmal hypertension due to baroreflex failure". Kidney Int. 74 (1): 126–31. doi:10.1038/ki.2008.30. PMID 18322544.