Uncontrolled hypertension in young adults-Pheochromocytoma/ paraganglioma

Pheochromocytomas are tumors that arise from the chromaffin cells of the adrenal medulla. They secrete high amounts of catecholamine namely norepinephrine and some amounts of epinephrine. Paragangliomas arise from the paraganglia of the sympathetic nervous system and usually secrete catecholamines.

Hypertension is the most common sign of pheochromocytoma, related to an excess amount of catecholamines and found in approximately 95% of patients.

Symptoms and diagnosis

Pheochromocytoma– the name is derived from- phaios (dusky), chroma (color), cytoma (tumor). 

If you suffer from hypertension, your endocrinologist will suggest tests for the investigation of hypertension including pheochromocytoma, if

  • He/she has classical symptoms of pheochromocytoma; elevated blood pressure and heart rate, flank pain, skin sensations, anxiety, sweating, palpitations, and weight loss.
  • If the patient falls in the age group of <20 years or >50 years of age and has resistant hypertension.
  • Has a family history of pheochromocytoma-associated hereditary syndromes.
  • Some patients are also detected with an incidental adrenal mass on imaging, which again, indicates this disorder.

Pheochromocytomas are fatal if they cause malignant hypertension, which results in severe high blood pressure leading to organ failure.

Role of Endocrine Surgeon: diagnosis, treatment, and follow-up

The experience of an endocrine Surgeon is vital in the diagnosis of suspected cases. Diagnosis is done by measuring the levels of catecholamines and metanephrines in the blood or 24- hour urine collection. Imaging like CT, MRI, and nuclear scanning of the head, neck, chest, and abdomen are also carried out.

Once the Pheochromocytoma is diagnosed and the tumor is identified, the next step is surgery. Laparoscopic resection is the standard procedure of treatment. A patient with pheochromocytoma has to be tested and monitored for cardiovascular conditions and blood pressure levels, prior to the surgery. The Endocrine Surgeon has to conduct the detection and treatment of malignant pheochromocytoma, chemoradiotherapy, and oversee the post-operative follow-up. Follow-up testing is essential and must be conducted on a yearly basis.

Wrap-up

If you suffer from uncontrolled hypertension, do consult your healthcare provider for further tests and investigations.

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