A pheochromocytoma is a tumor with predominant localization in the medulla of the adrenal glands, consisting of chromaffin cells and secreting large quantities of catecholamines. Pheochromocytoma is manifested by arterial hypertension and catecholamine hypertensive crises. In order to diagnose pheochromocytomas, they conduct provocative tests, determine the content of catecholamines and their metabolites in the blood and urine, ultrasound of the adrenal glands, CT and MRI, scintigraphy, selective arteriography. Treatment of pheochromocytoma is to perform adrenalectomy after appropriate medical preparation.
Pheochromocytoma (chromaffinoma) is a benign or malignant hormone-active tumor of the chromaffin cells of the sympathetic-adrenal system, capable of producing peptides and biogenic amines, including norepinephrine, adrenaline, dopamine. In 90% of cases, pheochromocytoma develops in the adrenal medulla; in 8% of patients localized in the area of aortic lumbar paraganglia; in 2% of cases – in the chest or abdominal cavity, in the small pelvis; extremely rarely (less than 0.1%) – in the head and neck. Endocrinology describes pheochromocytomas with intrapericardial and myocardial localization, with a predominant location in the left regions of the heart. Typically, pheochromocytoma is detected in individuals of both sexes aged 20–40 years; in children is more common among boys (60% of observations).
Malignant pheochromocytomas account for less than 10% of cases, they, as a rule, have extra-adrenal localization and produce dopamine. Metastatic malignant pheochromocyte occurs in the regional lymph nodes, muscles, bones, liver and lungs.
Symptoms of Pheochromocytoma
A pheochromocytoma secretes hormones that affect the entire body. The increase in adrenaline and norepinephrine most of all affects the cardiovascular, endocrine and nervous systems.
High blood pressure
With each beat, the heart throws out an increased amount of blood into the vessels. Under the action of catecholamines, vascular smooth muscles contract, reducing their lumen. This is accompanied by a significant increase in blood pressure in the arteries and veins.
At the same time systolic (upper) and diastolic (lower) pressure rises. There are two forms of the disease:
- Paroxysmal – occasionally there are sharp rises in pressure to -300 mm Hg. Art. During a hypertensive crisis, all the symptoms of the disease appear. A crisis ends suddenly after a few minutes or hours: pallor is replaced by reddening of the skin, abundant sweat and large amounts of urine are emitted.
- Permanent – persistent increase in blood pressure. The rest of the symptoms are moderate.
Heart rhythm disorders
Hormones stimulate the adrenoreceptors of the heart. In this regard, increases the strength and heart rate. Reflex excitation of the center of the vagus nerves, which slow down the activity of the heart. The result of such multidirectional effects are heart rhythm disorders – arrhythmias. “Fluttering” in the chest or neck is a manifestation of tachycardia. The feeling of “failure” during the disruption of the heart. Periods of acceleration or deceleration of the heart rhythm. Sternum pain. Weakness. Dyspnea.
Excitation of the nervous system
Catecholamines activate the processes of excitation in the spinal cord, cortex and brainstem, increase the transmission of impulses from the central nervous system to the organs. Anxiety, sense of fear. Chills, shivering. Increased fatigue, mood swings. Throbbing headache.
Increased gland activity
The activity of the glands increases, they secrete more secretion. Tearing. Viscous saliva secretion. Excessive sweating. The limbs are cool and wet.
Abdominal pain, diarrhea, constipation
Epinephrine stimulates the intestinal α and β adrenoreceptors. This slows the movement of food through the intestines and causes a reduction in sphincters. However, if the initial intestinal tone has been reduced, then adrenaline accelerates peristalsis and causes accelerated contractions of the intestine. Nausea. Abdominal pains caused by intestinal cramps. Delayed food masses in the intestines – constipation. Loose stools – diarrhea.
Pallor of the skin
Adrenaline causes a narrowing of the blood vessels of the skin. The skin is pale and cool to the touch. However, with a sharp increase in pressure, the skin turns red, patients feel flushing of the face.
Increased pressure can lead to retinal hemorrhage and detachment. Visual impairment. Moving dark spots in sight. Light flashes before eyes. Hyphema – red formation on the protein shell of the eye. Changes in the fundus detected during examination by an oculist.
Weight loss is associated with increased metabolism. Weight loss by 6-10 kg without changing the diet.