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Case 120

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A 63-year-old female patient complains of profuse sweating and palpitations. She does not report headache or tremor. The patient has a 10-year history of difficult-to-control hypertension and insulin-dependent type 2 diabetes. She also has family history of sudden death in first-degree relatives. She shows some laboratory results which lead the treating physician to order an abdominal computed tomography.

When evaluating patients with such clinical history, which biochemical testing must precede the imaging study?

a) Plasma catecholamines

25%

b) Vanillylmandelic acid

25%

c) 24-hour urinary catecholamines and metanephrines

25%

d) Plasma aldosterone levels and renin activity

25%
   

Comments

- Pheochromocytomas are catecholamine-secreting tumors which arise from chromaffin cells most often found in the adrenal medulla

- They are rare and usually benign. 15 to 20% of the cases occur in the setting of a hereditary syndrome.

- Clinical manifestations vary and might include the following: paroxysmal hypertension, tremor, pallor, cold extremities, classic triad (episodic headache, sweating and tachycardia), anxiety, sense of impending death, hard-to-control hypertension and family history of pheochromocytoma.

- The diagnosis is established with 24-hour urine testing for metanephrines and fractionated catecholamines measurements. The presence of at least one parameter over the threshold is considered diagnostic.

- Imaging studies to localize the tumor should only be performed after biochemical diagnosis of pheochromocytoma.

- Treatment of choice is surgical resection of the tumor.

References

Cecil, RL; Goldman, L; Ausiello, D. Cecil medicina. 23.ed. Rio de Janeiro: Elsevier, 2009. 2v. ISBN 9788535226607 (enc.).

Jr Young WF. Adrenal causes of hypertension: Pheochromocytoma and primary aldosteronism. Rev Endocr Metab Disord (2007) 8:309–320.

Jr Young WF, Kaplan NM. Clinical presentation and diagnosis of pheochromocytoma. Lacroix A, Martin KA, editor. UpToDate, 2013 [Acessed on July, 2013]. Available at: http://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-pheochromocytoma

Authors

Luanna da Silva Monteiro, 5th year medical student of UFMG School of Medicine

E-mail: luannasmonteiro[at]gmail.com

Maysa Teotonio Josafá Simão, 5th year medical student of UFMG School of Medicine

E-mail: maysateotonio[at]hotmail.com

Supervisor

Maria de Fátima Haueisen Sander Diniz, Member of the Department of Internal Medicine (UFMG School of Medicine)

Reviewers

Fabiana Resende and Glauber Eliazar

Translated by

Lucas Resende Lucinda, 6th year medical student of UFMG School of Medicine.
E-mail: lucasresendebh[at]hotmail.com

 

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