What hypertensive crises are caused by pheochromocytoma?

Pheochromocytoma is a benign tumor of the adrenal medulla, which belongs to the hormonally active type of tumors. Pheochromocytoma can also be from extraadrenal chromaffin tissue and is localized in most cases in one adrenal gland.

Why does pheochromocytoma appear? Causes of adrenal tumor development

To date, the cause of the formation of pheochromocytoma has not been fully studied and clarified. There is a strong opinion about the genetic nature of the origin of this adrenal tumor.

In childhood, pheochromocytoma affects boys more often, in adults it is more common in women aged 26 to 50 years. 10% of all cases have a familial form of the lesion.

Pheochromocytoma may accompany some tumors of the endocrine glands – thyroid cancer or parathyroid adenoma. A tumor of the adrenal glands can be malignant, but such cases are very rare.

How does pheochromocytoma manifest itself? Main clinical symptoms of pheochromocytoma

Pheochromocytoma can be either adrenal or extra-adrenal. With the development of adrenal pheochromocytoma, the secretion of catecholamines – epinephrine and norepinephrine.

When localized outside the adrenal glands, the secretion of norepinephrine alone increases, which does not affect metabolism so much. Therefore, a tumor of the adrenal glands always manifests itself brighter and is detected faster.

The most common symptom of pheochromocytoma – this is an increase in blood pressure, which is found in the form of hypertensive crises. Outside the crisis period, the pressure is kept at the level of the age norm. There are forms of pheochromocytoma that manifest themselves in constantly elevated blood pressure without the development of crises or with them.

People with pheochromocytoma have impaired metabolism, as evidenced by weight loss.

Features of hypertensive crisis in pheochromocytoma

Hypertensive crises are accompanied by many symptoms and disorders. These are metabolic disorders, gastrointestinal symptoms, nervous – mental and blood disorders. During such attacks with pheochromocytoma, a person feels anxiety, fear, trembling throughout the body, pain in the heart, palpitations, heart rhythm disturbance. Patients may feel nausea, dry mouth. Body temperature rises, sweating appears.

In the blood test, an increased amount of sugar, eosinophils, leukocytes and lymphocytes is observed. Symptoms may accompany a crisis in various combinations, not necessarily the presence of all symptoms at the same time.

The pheochromocytoma crisis ends as quickly as it begins. After the end of the attack, the pressure returns to normal, the skin of the face turns pink. There is profuse sweating and excretion of light urine up to 5 liters.

In a severe crisis with pheochromocytoma, retinal hemorrhage, pulmonary edema and acute cerebrovascular accident are possible.

Such crises appear suddenly on the background of alcohol intake, physical or mental overstrain, after hypothermia, or on the background of taking certain medications. The frequency of crises is not the same and can range from 15 times a day to once every few months, and the crisis can last from several minutes to several hours.

How to detect pheochromocytoma? Methods for diagnosing pheochromocytoma

In a blood test during a crisis, leukocytosis, lymphocytosis, an increase in eosinophils, an increase in the erythrocyte sedimentation rate, and an increase in fibrinolytic activity appear. In portions of urine after the crisis contains several times more catecholamines. Also in the urine there may be proteinuria, cylindruria and glucosuria.

For the purpose of diagnosis, the level of catecholamines in the blood is determined. In patients, the excretion of catecholamines increases sharply. The metabolite of catecholamines – vinylmandelic acid, the content of which exceeds the norm by 2-10 times and is up to 10 mg per day, normally this acid is not in the urine.

In all cases of arterial hypertension, in the absence of data on kidney damage, functional tests are performed using alpha – adrenergic blockers, which are indicated in the presence of arterial hypertension.

Scintigraphy, aortography, computed tomography, ultrasound of the abdominal organs are also performed for a comprehensive examination.

Pheochromocytoma can only be treated with surgery. The treatment process is long and begins only after the surgical removal of the adrenal tumor.

If for some reason the operation is not possible, a course of therapy with a drug from the alpha group is carried out – methyl – L- tyrosine.

The rest of the treatment consists of symptomatic therapy.