Department of Internal Diseases, Hypertension and Angiology The Medical University of Warsaw PHAEOCHROMOCYTOMA- Do classical symptoms help in diagnosis? Dorota Kwapisz, Marta Trafalska

PHAEOCHROMOCYTOMA   Phaeochromocytomas are catecholamine- producing neuroendocrine tumours arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia   It`s rare tumour with a highly variable clinical presentation

  Pts with paroxysmal signs or symptoms suggestive of a pheo The classical triad: headache sweating palpitations …hypertension   asymptomatic pts with an adrenal incidentaloma PHAEOCHROMOCYTOMA

PHAEOCHROMOCYTOMA Although the presence of the classical Although the presence of the classical triad of symptoms of pheo may lead to correct diagnosis, yet frequently diagnosis is establised during evaluation of incidentally discovered mass (incidentaloma)

THE AIM The aim of the study was: To asses clinical presentation of pheo in recent series of cases, To compare the pts. with pheo in whom the diagnostics was triggered by symptoms (S – ”Symptomatic”) with those in whom diagnostics began with incidental finding of adrenal mass (I – „Incidentaloma”)

DESIGN AND METHODS  n= 43 with pheo  mean age 47.4 ± 13.1 yrs  M/F 22/21  n= 29 „symptomatic”, n= 14 „incidentaloma”  n= 39 – pheo was located in the adrenals (1 bilateral – 1S) (1 bilateral – 1S) n= 4 – extraadrenal (1S/3I) n= 4 – extraadrenal (1S/3I)

DESIGN AND METHODS „S” SYMPTOMATIC „S” SYMPTOMATIC „I” INCIDENTALOMA „I” INCIDENTALOMA n (pts) n (pts) Mean age ± yrs ± yrs ± yrs ± yrs M/F 15/14 15/14 7/7 7/7 Malignant 1 1 MEN IIB 1 1

METHODS  Incidence of the most typical symptoms of pheo  Duration of hypertension  Urine excretion of metanephrines and catecholamine

METHODS   Automatic Blood Pressure Monitoring(ABP)   SpaceLabs   Mean, maximum, SD of 24SBP/24DBP   Echocardiography   Hewlett-Packard   LVMI

RESULTS Symptom S+ I S+ I S I p SWEATING 77 % 77 % 90 % 90 % 50 % 50 %<0,022 Headache Arrhythmias Palpitations Anxiety Pallor Triad Hypertension Weight loss

SYMPTOMS S 1. Sweating - 90% 2. Palpitations – 86% 3. Headaches – 78% The triad – 52% The triad – 52% I 1. Headaches – 62% 2. Sweating – 50% 3. Anxiety – 36% The triad – 14%

RESULTS – the triad

ABP S + I S + I S I 24SBP/24DBP 132/80 ± 16/10 133/79 ± 17/10 131/83 ± 14/10 24HR 79 ± ± ± ± ± 12 24SBP/24DBP- day/max 173/107177/107166/108 24SBP/24DBP - night/max 155/ / / 96 Duration of 5,43 ± 6,26 5,51 5,28 hypertension (yrs) (g/m2) LVMI (g/m2)

Metanephrines - mean: S-3790,50 I- 3365,30 p< 0,042 S : 270,8 –23666 I : 1375 – 10729,2

RESULTS S+I S I S+I S I Uricacid (mg/dl) 8,03 ± 15,03 9,20 5,38 p< 0,00(0) p< 0,00(0) Urea (mg/dl) 40,78 ± 25,08 41,99 37,90 p< 0,038 p< 0,038 Creatinine (mg/dl) 4,49 ± 22,19 6,17 0,86 p< 0,00(0) p< 0,00(0)

CONCLUSIONS   The incidence of classical symptoms may be lower than previously reported   Pheochromocytoma may mimic essential hypertension   Lack of sweating may be misleading and lead to wrong diagnosis