How it manifests itself: the classic triad and other signs
Doctors pay attention to a combination of three symptoms: paroxysmal headache, palpitations and profuse sweating against a background of high blood pressure. This combination does not occur in everyone, but it significantly increases the likelihood of diagnosis. An attack can be triggered by physical activity, bending, deep palpation of the abdomen, stress, certain medications, and even heavy food. After an attack, a person feels overwhelmed. Between episodes, you may feel normal, but sometimes your blood pressure remains high and does not respond well to conventional treatment.
- Paroxysmal headache
- Palpitations and feeling of irregularities
- Heavy sweat and paleness
- Anxiety and fear
- Trembling, nausea, abdominal or chest pain
- Weight loss and elevated sugar levels
- Persistent hypertension in some patients
When to look for a tumor
Pheochromocytoma is rare, so there is no need to screen everyone with high blood pressure. The search is justified in case of typical attacks, in case of hypertension that cannot be treated with several drugs, in case of sudden increases in pressure during operations and procedures, in case of an accidental discovery of an adrenal gland mass. A separate indication is hereditary syndromes: a significant proportion of cases are associated with genetic changes, so genetic testing is recommended for many patients, and regular monitoring is recommended for relatives.
- Classic triad of symptoms
- Treatment-resistant hypertension
- Increased pressure during anesthesia or manipulation
- Incidentally discovered adrenal mass
- Familial cases and hereditary syndromes
- Young age with high blood pressure
Diagnostics
First, they confirm the excess of hormones, and only then look for a tumor. To do this, determine metanephrines - metabolic products of adrenaline and norepinephrine - in the blood or daily urine; they are more reliable than the hormones themselves because they are released constantly. The preparation rules are strict: the doctor tells you in advance which drugs and foods to exclude, how to collect urine. If excess is confirmed, a CT scan or MRI of the adrenal glands is performed, and, if necessary, studies to look for tumors outside the adrenal gland. Additionally, the heart, sugar and electrolytes are assessed.
- Metanephrines in blood or daily urine
- Strict adherence to the rules of preparation for analysis
- Computed tomography of the adrenal glands
- MRI with contraindications to contrast
- Search for paragangliomas with a negative picture of the adrenal glands
- ECG, echocardiography, 24-hour blood pressure monitoring
- Genetic testing according to indications
Preparing for surgery: why you can’t skip it
Operating on a pheochromocytoma without preparation is dangerous: during manipulations on the tumor, a large amount of hormones are released into the blood, which causes a severe crisis, and after removal the pressure can drop sharply. Therefore, several weeks before the intervention, drugs that block the action of these hormones are prescribed, gradually adjusting the dose. The patient is advised to increase fluid and salt intake as directed by the doctor to replenish blood volume. Only after achieving stable blood pressure and pulse values does the surgeon plan the operation.
- Blocking therapy several weeks before surgery
- Gradual dose selection under pressure control
- Increasing drinking regime and salt consumption as prescribed by a doctor
- Control of pulse and orthostatic reactions
- Planned hospitalization and joint management with an anesthesiologist
- Operation only after stabilization of indicators
Operation and observation after
The tumor is removed along with the adrenal gland or, if it is small, with part of the gland preserved; Laparoscopic access is more often used. After removal, the pressure usually normalizes, attacks stop, and metabolic disorders decrease. However, observation is necessary for a long time: relapses, a second tumor in another adrenal gland or a paraganglioma of a different localization are possible, especially in hereditary forms. Therefore, the doctor prescribes periodic monitoring of metanephrines and imaging on an individual schedule. With bilateral removal, lifelong replacement therapy is required.
- Laparoscopic tumor removal
- Preservation of part of the adrenal gland in a small size
- Blood pressure control in the early postoperative period
- Periodic monitoring of metanephrines
- Monitoring relatives with hereditary forms
- Replacement therapy when both adrenal glands are removed
