Pheochromocytoma differential diagnosis: Difference between revisions

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Revision as of 20:31, 15 August 2017

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: Palpitations (especially in epinephrine producing tumors)^[3] Anxiety Sweating Headaches (90 % of patients) Paroxysmal attacks of hypertension May be asymptomatic (incidentally discovered in MEN syndrome patients)	Tachycardia Hypertension, including paroxysmal (sporadic, episodic) high blood pressure, which sometimes can be more difficult to detect. Orthostatic hypotension	High-risk patients: Plasma fractionated metanephrines 24-hour urinary fractionated metanephrines, catecholamines Imaging studies (CT scan, MRI and iodine-123-meta-iodobenzylguanidine or MIBG scintiscan)^[2] Low-risk patients: 24-hour urinary fractionated catecholamines and metanephrines.^[4]
Pseudopheochromocytoma^[1]^[2]^[3]^[4]	Paroxysmal activation of the sympathetic system causing: Emotional distress Acute onset of high blood pressure Headache Chest pain Nausea Palpitations Flushing Duration of attacks ranges from minutes to hours Physical symptoms occur before feeling fear	Hypertension Tachycardia	Increase in plasma catecholamines between and during attacks.
Panic attacks	Paroxysms of increased sympathetic activity Episodes of fear or panic attacks Chest pain Headache Palpitations Flushing Response to antidepressants Fear precedes physical symptoms.		Laboratory studies that can exclude medical disorders other than panic disorder include: Serum electrolytes Serum glucose Cardiac enzymes Urine toxicology screening
Labile hypertension (White coat hypertension)	Elevated blood pressure in a clinical setting but not in other settings^[1]		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.
Hyperthyroidism	Weight loss Heat intolerance Tremors Palpitations Anxiety Increased bowel disturbances Shortness of breath^[5]	Goiter Skin flushing Proptosis Increased sensitivity of beta receptors in the heart to catecholamines^[6] due to an effect of thyroid hormones increase cardiac work and output Systolic hypertension^[7]	Low thyroid-stimulating hormone (TSH) High free thyroxine (T4) concentration High triiodothyronine (T3) concentration
Renovascular hypertension	Common in individuals < 30 years or > 55 years Abrupt onset of hypertension Accelerated hypertension that was previously well-controlled Refractory hypertension to 3 anti-hypertensive medications Headache Nausea Subconjunctival hemorrhage	Bruit can be heard over the abdomen	Duplex ultrasonography may be used as an initial screening tool for diagnosis of atherosclerotic renal artery stenosis Ultrasonography (might not be very accurate in obese patients or those with intestinal gas)^[1]
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^[8]		CT shows mass compressing lateral medulla or infarction in the same area
Seizures	According to type; it may be focal or generalized, clinical or subclinical: tonic-clonic seizure: Repetitive twitches of arm and legs Tongue bitting Loss of consciousness Symptoms occur suddenly and may persist Muscle tension or tightening that causes twisting of the body, head, arms, or legs Amnesia Mood changes (fear, panic, or laughter) Change in sensation of the skin over the arm, leg, or trunk Vision changes and light flashes Hallucinations Tasting a bitter or metallic flavor Complex partial seizure: Confused or dazed and Not be able to respond to questions or direction Absence seizure: Rapid blinking Few seconds of staring into space		Abnormal electroencephalography Positive test without a clinical presentation is called a sub-clinical seizure
Carcinoid syndrome	Hypertensive crisis occurs with malignant carcinoid syndrome^[9]. Symptoms include: Severe chest pain Severe headache Confusion and blurred vision Nausea and vomiting Severe anxiety Shortness of breath Seizures Unresponsiveness	Cutaneous flushing Venous telangiectasia Diarrhea Bronchospasm Cardiac valvular lesions (tricuspid incompetence)	High urinary excretion of 5-HIAA^[10] High urinary excretion of serotonin^[11] High chromogranin concentration(Chromogranin(A, B, and C) are proteins that are stored and released with peptides and amines in a variety of neuroendocrine tissues)^[12] CT is recommended for evaluation of all patients with carcinoid tumors.^[13]
Migraine headaches	Prodrome: Occurs hours or days before a headache Aura Immediately precedes the headache Pain phase Also known as headache phase Postdrome phase^[14]	Conjunctival injection Horner's syndrome^[1] Adie's pupil ^[2] Cranial/ cervical muscle tenderness Bruit at neck and head for clinical signs of an arteriovenous malformation Photosensitivity	CT is indicated in patients with:^[1]^[2] Abnormal physical examination: Increase of headache's frequency Poor coordination Focal neurologic signs Headaches awakening the patient at nigt^[3][4] Atypical aura Sudden onset Lasting more than 1 hour Always on the same side With or without visual symptoms Migraine attacks that begin after 50 years of age CT is not indicated in: Patients with a diagnosis of a migraine in accordance with the criteria for migraine Differentiating a migraine from other primary headaches
Drugs	Sympathomimetic drugs that can induce symptoms simulating pheochromocytoma include: High-dose phenylpropanolamine Cocaine Amphetamines Lysergic acid diethylamide (LSD) Phenylcyclidine (PCP)^[15] Combination of a monoamine oxidase (MAO) inhibitor and ingestion of tyramine-containing foods.^[16]	Disturbed consciousness Nasal septum perforation in cocaine addiction Needle marks on the skin History of antidepressantintake	Urine toxicology screening
Baroreflex failure	Marked and frequent fluctuations in blood pressure,^[17] with both high and low readings It is caused by hypofunctioning of baroreflexes that normally buffer blood pressure fluctuations The disorder is usually a result of injury to carotid baroreceptors, with most patients reporting a history of neck irradiation or surgery^[18]		Neck CT scan

↑ 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.
↑ 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.
↑ Phillips AM, Jardine DL, Parkin PJ, Hughes T, Ikram H (2000). "Brain stem stroke causing baroreflex failure and paroxysmal hypertension". Stroke. 31 (8): 1997–2001. PMID 10926969.
↑ 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.
↑ 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.
↑ 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.

[pmid102187452-1] Mann SJ (1999). "Severe paroxysmal hypertension (pseudopheochromocytoma): understanding the cause and treatment". Arch Intern Med. 159 (7): 670–4. PMID 10218745.

[pmid10218745-2] Mann SJ (1999). "Severe paroxysmal hypertension (pseudopheochromocytoma): understanding the cause and treatment". Arch Intern Med. 159 (7): 670–4. PMID 10218745.

[pmid8824124-3] 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.

[pmid17921824-4] 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.

[pmid15963064-5] 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.

[pmid20454652-6] 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.

[pmid2045465-7] 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.

[pmid10926969-8] Phillips AM, Jardine DL, Parkin PJ, Hughes T, Ikram H (2000). "Brain stem stroke causing baroreflex failure and paroxysmal hypertension". Stroke. 31 (8): 1997–2001. PMID 10926969.

[pmid7969229-9] 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.

[pmid3227292-10] Sjöblom SM (1988). "Clinical presentation and prognosis of gastrointestinal carcinoid tumours". Scand J Gastroenterol. 23 (7): 779–87. PMID 3227292.

[pmid2421946-11] Feldman JM (1986). "Urinary serotonin in the diagnosis of carcinoid tumors". Clin Chem. 32 (5): 840–4. PMID 2421946.

[pmid2316306-12] 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.

[pmid19077417-13] 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.

[pmid15447695-14] 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.

[pmid11358774-15] Krentz AJ, Mikhail S, Cantrell P, Hill GM (2001). "Drug Points: Pseudophaeochromocytoma syndrome associated with clozapine". BMJ. 322 (7296): 1213. PMC 31620. PMID 11358774.

[pmid3980057-16] Kuchel O (1985). "Pseudopheochromocytoma". Hypertension. 7 (1): 151–8. PMID 3980057.

[pmid183225442-17] 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.

[pmid18322544-18] 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.

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@@ Line 33: / Line 33: @@
 * '''Low-risk patients''':
-** 24-hour [[urinary]] fractionated [[catecholamines]] and [[Metanephrine|metanephrines]]<sup>[[Pheochromocytoma laboratory findings#cite note-pmid12574179-4|[4]]]</sup>
+** 24-hour [[urinary]] fractionated [[catecholamines]] and [[Metanephrine|metanephrines]].<sup>[[Pheochromocytoma laboratory findings#cite note-pmid12574179-4|[4]]]</sup>
 |-
 |Pseudopheochromocytoma<ref name="pmid102187452">{{cite journal| author=Mann SJ| title=Severe paroxysmal hypertension (pseudopheochromocytoma): understanding the cause and treatment. | journal=Arch Intern Med | year= 1999 | volume= 159 | issue= 7 | pages= 670-4 | pmid=10218745 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10218745  }}</ref><ref name="pmid10218745">{{cite journal| author=Mann SJ| title=Severe paroxysmal hypertension (pseudopheochromocytoma): understanding the cause and treatment. | journal=Arch Intern Med | year= 1999 | volume= 159 | issue= 7 | pages= 670-4 | pmid=10218745 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10218745  }}</ref><ref name="pmid8824124">{{cite journal| author=Mann SJ| title=Severe paroxysmal hypertension. An automatic syndrome and its relationship to repressed emotions. | journal=Psychosomatics | year= 1996 | volume= 37 | issue= 5 | pages= 444-50 | pmid=8824124 | doi=10.1016/S0033-3182(96)71532-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8824124  }}</ref><ref name="pmid17921824">{{cite journal| author=Sharabi Y, Goldstein DS, Bentho O, Saleem A, Pechnik S, Geraci MF et al.| title=Sympathoadrenal function in patients with paroxysmal hypertension: pseudopheochromocytoma. | journal=J Hypertens | year= 2007 | volume= 25 | issue= 11 | pages= 2286-95 | pmid=17921824 | doi=10.1097/HJH.0b013e3282ef5fac | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17921824  }}</ref>
@@ Line 230: / Line 230: @@
 |}
-{| class="wikitable"
+{{Reflist|2}}
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Disease}}
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Prominent clinical features}}
-! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Investigations}}
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Hyperthyroidism}}
-|The main symptoms include:
-* [[Palpitations]]
-* [[Insomnia]]
-* [[Anxiety]]
-* [[Weight loss]]
-* Heat intolerance
-* [[Diarrhea]]
-* Depending on the underlying diagnosis, the patient might have [[exophthalmus]] or [[goiter]]
-|
-* The patient usually has elevated [[T3]] and [[T4]]
-* [[TSH]] might be increased or decreased depending on the underlying cause
-* [[TSI|Thyroid stimulating antibodies (TSI)]] might be increased in cases of [[Graves’ disease]]
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Essential hypertension}}
-|Most patients with hypertension are asymptomatic at the time of diagnosis. Common symptoms are listed below:
-*[[Headache]]
-*[[Blurry vision]]
-*[[Dyspnea]]
-*[[Epistaxis]]
-*[[Tinnitus]]
-*[[Fatigue]]
-*[[Drowsiness]]
-|JNC 7 recommends the following routine laboratory tests before initiation of therapy for hypertension''':'''
-*[[ECG|12-Lead electrocardiogram (ECG)]]
-*[[Urinalysis]], including urinary albumin excretion or albumin/creatinine ratio
-*[[Blood glucose]]
-*[[Hematocrit|Blood hematocrit]]
-*[[Electrolyte|Serum electrolytes]], especially [[potassium]]
-*[[Calcium|Serum calcium]]
-*[[Lipid profile]]: [[Total cholesterol]], [[LDL]], [[HDL]], [[triglycerides]]
-*[[Creatinine]] or estimated [[GFR]]
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Generalized anxiety disorder}}
-|According to DSM V, the following criteria should be present to fit the diagnosis of [[generalized anxiety disorder]]:
-#The presence of sense of apprehension or fear toward certain activities for most of the days for at least 6 months
-#Difficulty to control the apprehension
-#Associated restless, fatigue, irritability, difficult concentration, muscle tension or sleep disturbance (only one of these manifestations)
-#The anxiety or the physical manifestations must affect the social and the daily life of the patient
-#Exclusion of another medical condition or the effect of another administered substance
-#Exclusion of another mental disorder causing the symptoms
-|<nowiki>-</nowiki>
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Menopause}}
-|The [[perimenopausal]] symptoms are caused by an overall drop, as well as dramatic but erratic fluctuations, in the levels of [[estrogens]], [[progestin]], and [[testosterone]]. Some of these symptoms such as [[formication]] etc may be associated with the hormone [[withdrawal]] process.
-*Vasomotor instability in the form of [[hot flush]]es, including [[sleep hyperhidrosis|night sweats]] and [[Sleep disorder|sleep disturbances]]
+[[Category:Endocrinology]]
-*Urogenital atrophy causing [[Itch|itching]], dryness, [[bleeding]], watery discharge, [[Polyuria|urinary frequency]], [[urinary urgency]] and [[urinary incontinence]]
-*Skeletal symptoms in the form of [[osteoporosis]] (gradually developing over time), [[arthralgia|artharlgia]], [[myalgia|myalgia]] and [[back pain]]
-*Psychological manifestations such as [[Mood disorder|mood disturbance]], [[irritability]], [[Fatigue (medical)|fatigue]], [[memory loss]] and [[Depression (mood)|depression]]
-*Sexual disorders: [[Libido|decreased libido]], [[Vaginal lubrication|vaginal dryness]], problems reaching orgasm and [[dyspareunia]]
-|
-* [[Human chorionic gonadotropin|B-HCG]] should always be done first to rule out [[pregnancy]] especially in women under the age of 45 years
-* [[FSH]] can be measured but it can be falsely normal or low
-* [[TSH]], [[T3]] and [[T4]] to rule out thyroid abnormalities
-* [[Prolactin]] can be measured to rule out [[prolactinoma]] as a cause of [[menopause]]
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Opioid withdrawal disorder}}
-|According to DSM V, the following criteria should be present to fit the diagnosis of opioid withdrawal:
-# Cessation of (or reduction in) [[Opioid use disorders|opioid use]] that has been heavy and prolonged (i.e.,several weeks or longer) or administration of an [[opioid antagonist]] after a period of [[Opioid use disorders|opioid use]].
-# Development of three or more of the following criteria minutes to days after cessation of drug use: [[Dysphoria|dysphoric mood]], [[nausea]] or [[vomiting]], [[muscle aches]], [[Lacrimation]] or [[rhinorrhea]], [[pupillary dilation]], [[piloerection]], or [[sweating]], [[diarrhea]], [[yawning]], [[fever]], and [[insomnia]].
-# The signs or symptoms mentioned above must cause impairment of the daily functioning of the patient.
-#  The signs or symptoms mentioned above must not be attributed to other medical or mental disorders.
-|
-* Urine drug screen to rule out any other associated drug abuse
-* Routine blood work such as electrolytes and hemoglobin to rule out any associated disease explaining the symptoms
-|-
-| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Pheochromocytoma}}
-|The hallmark symptoms of a [[pheochromocytoma]] are those of [[sympathetic nervous system]] hyperactivity, symptoms usually subside in less than one hour and they may include:
-*[[Palpitations]] especially in epinephrine producing tumors.
-*[[Anxiety]] often resembling that of a [[panic attack]]
-*[[Sweating]]
-*[[Headaches]] occur in 90 % of patients.
-*Paroxysmal attacks of [[hypertension]] but some patients have normal blood pressure.
-*It may be asymptomatic and discovered by incidence screening especially [[MEN, type 2|MEN]] patients.
-''Please note that not all patients with pheochromocytoma experience all classical symptoms''.
-|Diagnostic lab findings associated with pheochromocytoma include:
-*Elevated plasma and urinary [[catecholamine]]s and [[metanephrine]]s
-*Elevated urinary [[vanillyl mandelic acid]]
-|}
-{{Reflist|2}}

Pheochromocytoma differential diagnosis: Difference between revisions

Revision as of 20:31, 15 August 2017

Overview

Differentiating pheochromocytoma from other diseases

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