Pheochromocytoma: Symptoms and Treatment


Pheochromocytoma is a benign or malignant tumor that consists of extraadrenal chromaffin tissue, as well as the adrenal medulla. More often, the formation affects only one adrenal gland and has a benign course. It is worth noting that the exact causes of the progression of the disease have not yet been established by scientists. In general, adrenal pheochromocytoma is rare. Usually, the tumor begins to progress in people aged 25 to 50 years. But the formation of pheochromocytoma in children, especially in boys, is not excluded.

Pheochromocytoma is a tumor that has good enough circulation and is surrounded by a specific capsule. The sizes of the formation are different — from 1 cm to 14 cm. It has been established that the tumor grows quite rapidly. For the year it can increase by 7 mm. It is worth noting that only in 10% of cases a malignant pheochromocytoma is formed in a person, completely consisting of cancer cells.

Tumor formation can be localized both on the adrenal gland and in its immediate vicinity. Located outside the gland, the tumor secretes only one type of hormones — noradrenaline, so the symptoms of the pathology will be much softer (the hormone has a more gentle effect on the entire body).

Etiology

The exact causes of the progression of pheochromocytoma have not yet been established. But scientists have several theories about this:


  • hereditary predisposition. In the course of the research it was found that 10% of patients who had a pathology diagnosis had direct relatives with the same diagnosis. Therefore, scientists suggest that the development of the disease is directly related to the mutation of the gene responsible for the full functioning of the adrenal glands. As a consequence, the cells of the brain substance begin to grow rapidly,
  • Gorlin’s syndrome and Sipple’s syndrome. These are two hereditary ailments, the characteristic feature of which is the uncontrolled proliferation of glandular cells of the endocrine system. In this case, not only the adrenal glands are affected, but also the thyroid gland, muscle and bone structures, etc.

In most clinical situations, clinicians can not identify the true cause of tumor formation.

Symptoms

The main sign, indicating the appearance and growth of pheochromocytoma, is an increase in blood pressure, which occurs with regular hypertensive crises. It is worth noting that the increase in blood pressure is observed only in the crisis period, it stabilizes in the intercrysian one. Less commonly, the form of pheochromocytoma is diagnosed, under which the pressure does not stabilize independently.

The crisis with pheochromocytoma is characterized by the appearance of such symptoms:


  1. chills;
  2. pallor of the skin;
  3. trembling in the whole body
  4. a headache that tends to increase with a sharp change in position
  5. pain syndrome in the heart and behind the breastbone
  6. dizziness;
  7. arrhythmia;
  8. tachycardia
  9. nausea and vomiting
  10. dryness in the mouth
  11. Sweating
  12. temperature may increase.

Symptoms of pheochromocytoma appear after:


  • hypothermia or strong overheating of the body
  • committing sudden movements
  • physical overvoltage;
  • emotional stress
  • alcohol consumption in large quantities
  • taking certain groups of medications.

The hypertensive crisis in a patient with a pheochromocytoma starts quickly and ceases as quickly. The pressure can independently normalize itself. Some time after the crisis, there may be hyperemia of the skin, increased sweating. In severe situations, signs of hemorrhage into the reticulum, pulmonary edema, and circulation of blood in the brain may join the symptoms of pheochromocytoma.

The stable form of the tumor is characterized by:


  1. permanently elevated blood pressure
  2. impaired kidney function;
  3. headache;
  4. the patient is overly excited.

Symptoms of pheochromocytoma, indicating a metabolic disorder:


  • diarrhea;
  • weight loss
  • increase in blood sugar levels
  • increased sweating.

Diagnostics

The presence of a tumor can be determined by the hormonal background of a person. The fact is that education secretes hormones for a certain period of time, so it is important to conduct a blood test in the first few hours after the end of the attack. It is also necessary to pass urine. In the blood and urine determine the presence of adrenaline, norepinephrine, metanephrine.





Instrumental techniques for diagnosing pheochromocytoma:


  1. Ultrasound. This method of diagnosing pheochromocytoma makes it possible to determine the exact location of the tumor, to establish its dimensions;
  2. CT of the adrenal gland
  3. MRI of organs localized in the retroperitoneal space
  4. adrenal scintigraphy

Treatment

Treatment of pheochromocytoma is performed exclusively in stationary conditions. During the crisis, the victim is shown a strict bed rest. The head of the bed always rises. Drug treatment is prescribed only by a doctor, after evaluating the results of the tests, and also taking into account the patient’s condition and the severity of his illness.

Medication of pheochromocytoma:


  • alpha-blockers
  • beta-blockers
  • calcium channel blockers

Some patients, after setting such a diagnosis, are beginning to be actively treated with folk remedies. Doing this is strictly prohibited, because you can only aggravate the course of the disease. It is also worth noting that if there is such a disease, no folk remedies will help. Only official methods will help to remove education and reduce the risk of its re-growth.

The doctors resort to surgical treatment in the presence of:


  1. hormone-active education
  2. hormonal inactive formation, whose dimensions exceed 4 cm

Contraindications to surgical intervention:


  • age over 70;
  • blood clotting disorder
  • the patient’s general severe condition. The operation is allowed only after its stabilization;
  • increase or decrease in blood pressure to critical figures, which can not be normalized.

Types of surgical interventions:


  1. public access. In this case, the doctor produces a large incision under the ribs to detect and remove the tumor. This method is rarely used, since it is very traumatic. It is used in the presence of simultaneous defeat of two adrenals, and also if diagnostic methods failed to establish the localization of education accurately
  2. Laparoscopic surgery. A more modern and atraumatic method of removing education. Access to the adrenal gland is made on the abdominal wall — the surgeon makes two small incisions. Through the incisions, a special instrument is introduced, by means of which the tumor is removed along with the adrenal gland. After this, the doctor restores the integrity of the abdominal wall.

Recently, doctors have resorted to retroperitoneoscopic surgery. In this case, access to the tumor is through the lumbar region. To ensure that the hormones released by her do not get into the bloodstream and do not provoke a new attack of a crisis, the doctors immediately cut off the blood vessels that feed the neoplasm. The tumor is placed in a special container, where it is crushed, and removed through small holes.

Most doctors are confident that it is surgical techniques that are most effective. They make it possible to completely remove the tumor, as well as normalize the patient’s general condition (stabilize blood pressure, eliminate intoxication syndrome, etc.). The risk of forming a new tumor is minimized.