Pheochromocytoma physical examination: Difference between revisions
No edit summary |
No edit summary |
||
Line 18: | Line 18: | ||
=== Vital Signs === | === Vital Signs === | ||
* [[Tachycardia]] with a regular pulse. The irregular pulse occurs in supraventricular tachycardia. | * [[Tachycardia]] with a regular pulse. The irregular pulse occurs in [[supraventricular tachycardia]]. | ||
* Tachypnea/bradypnea if malignant secondaries found in the lung. Dyspnea occurs in patients with complicated heart failure and cardiomyopathy. | * [[Tachypnea]]/[[bradypnea]] if malignant secondaries found in the [[lung]]. [[Dyspnea]] occurs in patients with complicated heart failure and [[Cardiomyopathy|cardiomyopathy.]] | ||
* Rapid strong equal pulse | * Rapid strong equal [[pulse]] | ||
* High blood pressure with normal pulse pressure | * High blood pressure with normal pulse pressure | ||
* Hypotension occurs due to fluid contraction | * [[Hypotension]] occurs due to fluid contraction. | ||
=== Skin === | === Skin === | ||
* [[Jaundice]] if liver malignant secondaries affected liver functions. | * [[Jaundice]] if liver malignant secondaries affected [[liver]] functions. | ||
=== Head === | === Head === | ||
* Abnormalities of the head may include: | * Abnormalities of the head may include: | ||
* Facial flushing | * Facial flushing | ||
* Scleral icterus if liver malignant secondaries affected liver functions. | * [[Icterus|Scleral icterus]] if liver malignant secondaries affected liver functions. | ||
* MEN2 patients associated with mucosal neuromas show multiple lips and tongue neuromas. | * [[MEN2]] patients associated with mucosal neuromas show multiple lips and tongue [[Neuroma|neuromas]]. | ||
=== Neck === | === Neck === | ||
* Congested neck veins in cardiomyopathy associated patients.<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> | * Congested neck veins in [[cardiomyopathy]] associated patients.<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> | ||
* [[Lymphadenopathy]] if malignant secondaries found in the neck (firm, a rapid increase in the size of the node and painless). Prevalence of malignancy in 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> | * [[Lymphadenopathy]] if malignant secondaries found in the neck (firm, a rapid increase in the size of the node and painless). Prevalence of malignancy in 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 MEN patient associated with medullary thyroid malignancy<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> | * [[Thyromegaly]]/thyroid nodules if MEN patient associated with medullary thyroid malignancy.<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 === | === Lungs === | ||
* Asymmetric chest expansion / Decreased chest expansion if malignant | * Asymmetric chest expansion / Decreased chest expansion if malignant secondaries are found in the lung. | ||
=== Heart === | === Heart === | ||
* Chest tenderness upon palpation in MEN1 patients associated with hyperparathyroidism | * Chest [[tenderness]] upon palpation in [[MEN1]] patients associated with hyperparathyroidism. | ||
* Palpation: | * [[Palpation]]: Pericardial heave especially at apex due to left ventricular hypertrophy in long standing patients. | ||
* Auscultation: normal s1 and accentuated s2 due to high systemic resistance. | * Auscultation: normal s1 and accentuated s2 due to high systemic resistance. | ||
=== Abdomen === | === Abdomen === | ||
* [[Abdominal distention]] in patients with primary hyperparathyroidism associated constipation or Hirschsprung disease | * [[Abdominal distention]] in patients with primary hyperparathyroidism associated constipation or Hirschsprung disease. | ||
* [[Abdominal tenderness]] in the lower abdominal quadrants in MEN2 patients with 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> | * [[Abdominal tenderness]] in the lower abdominal quadrants in 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 | * A palpable abdominal mass in the lower abdominal quadrant. | ||
* Guarding may be present | * [[Abdominal guarding|Guarding]] may be present. | ||
* [[Hepatomegaly]] if malignant secondaries found in liver | * [[Hepatomegaly]] if malignant secondaries found in liver. | ||
* Diarrhea caused by gastrointestinal secretion of fluid and 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> | * [[Diarrhea]] caused by gastrointestinal secretion of fluid and 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 === | === Back === | ||
* Point tenderness in MEN1 patients with hyperparathyroidism | * Point tenderness in [[MEN1]] patients with [[hyperparathyroidism]]. | ||
==References== | ==References== |
Revision as of 14:18, 31 July 2017
Pheochromocytoma Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Pheochromocytoma physical examination On the Web |
American Roentgen Ray Society Images of Pheochromocytoma physical examination |
Risk calculators and risk factors for Pheochromocytoma physical examination |
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
Common physical exam findings of pheochromocytoma include tachycardia, hypertension, and orthostatic hypotension.
Physical Examination
Appearance of the Patient
Patients appear tired, weak, sweaty with anxious appearance[1].
Patients may appear quite well in asymptomatic patients.
Patients may appear flushed due to associated increase in erythropoietin secretion.[2]
Patients may appear obese due to complicated type2 DM and Cushing syndrome.[3]
Vital Signs
- Tachycardia with a regular pulse. The irregular pulse occurs in supraventricular tachycardia.
- Tachypnea/bradypnea if malignant secondaries found in the lung. Dyspnea occurs in patients with complicated heart failure and cardiomyopathy.
- Rapid strong equal pulse
- High blood pressure with normal pulse pressure
- Hypotension occurs due to fluid contraction.
Skin
Head
- Abnormalities of the head may include:
- Facial flushing
- Scleral icterus if liver malignant secondaries affected liver functions.
- MEN2 patients associated with mucosal neuromas show multiple lips and tongue neuromas.
Neck
- Congested neck veins in cardiomyopathy associated patients.[4]
- Lymphadenopathy if malignant secondaries found in the neck (firm, a rapid increase in the size of the node and painless). Prevalence of malignancy in lymph node biopsies performed is 60%.[5]
- Thyromegaly/thyroid nodules if MEN patient associated with medullary thyroid malignancy.[6]
Lungs
- Asymmetric chest expansion / Decreased chest expansion if malignant secondaries are found in the lung.
Heart
- Chest tenderness upon palpation in MEN1 patients associated with hyperparathyroidism.
- Palpation: Pericardial heave especially at apex due to left ventricular hypertrophy in long standing patients.
- Auscultation: normal s1 and accentuated s2 due to high systemic resistance.
Abdomen
- Abdominal distention in patients with primary hyperparathyroidism associated constipation or Hirschsprung disease.
- Abdominal tenderness in the lower abdominal quadrants in MEN2 patients with Hirschsprung disease.[7]
- A palpable abdominal mass in the lower abdominal quadrant.
- Guarding may be present.
- Hepatomegaly if malignant secondaries found in liver.
- Diarrhea caused by gastrointestinal secretion of fluid and electrolytes, and flushing in medullary thyroid cancer patients.[8]
Back
- Point tenderness in MEN1 patients with hyperparathyroidism.
References
- ↑ Bravo EL, Gifford RW (1993). "Pheochromocytoma". Endocrinol Metab Clin North Am. 22 (2): 329–41. PMID 8325290.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ HEINRICH WA, JUDD ES (1948). "A critical analysis of biopsy of lymph nodes". Proc Staff Meet Mayo Clin. 23 (21): 465–9. PMID 18888946.
- ↑ 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.
- ↑ 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.
- ↑ 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.