Pheochromocytoma

Group 9
Pros, Eugene Cary
Labrador, Astrud
Pangilinan, Coleen

Case:
A 48 year old man with a 1 history of refractory hypertension as
well as occasional symptoms of panic attacks is referred to a
hypertension clinic. 24 hour cathecolamine was order by the
attending physician:

Lab test for 24 hour urine cathecolamines:

Vanillymandelic acid: 98 (<6mg)
Metaneprine: 169 (45-290ug)
Normetanephrine: 2807 (85-500ug)
Epinephrine 14 (2-24ug)
Norepinephrine 784 (15-100ug)

Pheochromocytoma
Pheochromocytoma is a rare tumor that can
form in cells in the middle of the adrenal glands.
Which can cause the adrenal glands to make too
much of the hormones norepinephrine and
epinephrine

Summary of the case

The following are the basic information about
the man:

48 year old man

Have a 1 history of refractory
hypertension
Occasional symptoms of panic attacks
(hypertension clinic)

From the information gathered in the history and

examination, the following differential diagnosis can

be posited:

The 48 year old man is suffering from a rare

disease called pheochromocytoma

Lab test results for 24

hour urine
cathecolamines:
Vanillymandelic acid: 98
(<6mg)
Metaneprine: 169 (45-290ug)
Normetanephrine: 2807 (85500ug)
Epinephrine 14 (2-24ug)
Norepinephrine 784 (15100ug)

Answers to QFRS

1. Explain briefly the pathophysiology of

Pheochromocytoma
The clinical indicators of a pheochromocytoma result from:
Excessive catecholamine secretion by the tumor.
Catecholamines typically secreted are norepinephrine
and epinephrine; some tumors produce dopamine.
The effects of catecholamines are:
alpha-adrenergic receptors - results in elevated
blood pressure, increased cardiac contractility,
glycogenolysis, gluconeogenesis, and intestinal
relaxation
beta-adrenergic receptors results in an increase in
heart rate and contractility.

2. What are the abnormal results? Give the

indication
of these results
For a 24-hour urine collection, the following values are
associated with the presence of pheochromocytoma:
NE >170ug/24h
EPI >35ug/24h
Dopamine >700ug/24h
Normetanephrine >900ug/24h
or metanephrine >400ug/24h

3. Give the characteristics signs and symptoms of

Palpitations
the
disease
Diaphoresis
Abdominal pain
Chest pain
Irritability
Rapid heart rate
Severe headache
Other symptoms that can occur with this disease are Hand tremor, High
blood pressure, and sleeping difficulty.

4. Indication for screening Pheochromocytoma

Different tests for diagnosis of

Pheochromocytoma.
Screening tests:
Plasma metanephrines- help detect and diagnose the
presence of a catecholamine-secreting tumor. Tumor
normetanephrines by HPLC (four fold increased)
Diagnostic Test:
24 hour urinary excretion of metanephrines and
normetanephrines (increased levels)

Different tests for diagnosis of

Pharmacologic Tests:
Pheochromocytoma.
Clonidine Test- differentiates pheochromocytoma to
neurogenic hypertension.
- It is only used when plasma cathecolamines are
greater than 1000 pg/ml
Glucagon Stimulation Test- only used for individuals
with normal blood pressure and when cathecolamines are
only elevated.

REFERENCES
Place your screenshot here

Clinical
Chemistry
Principles,
Techniques, and
Correlations By
Bishop pages
471-474
Clinical
Chemistry
Review
Handbook by
Maria Theresa