Angeles University Foundation

College of Allied in Medical Profession

Pheochromocytoma
Submitted to: Mr. Franzielle Jowe Cabrera
Mr. Raphael Enrique Tiongco

Submitted by:
MT3E Group 9
Pros, Eugene Cary
Labrador, Astrud
Pangilinan, Coleen

I.

Introduction

Case Analysis:
A 48 year old man with a 1 history of refractory hypertension as well
as occasional symptoms of panic attacks is referred to a hypertension
clinic. 24 hour cathecolamine was order by the attending physician.
Lab test for 24 hour urine cathecolamines:
Vanillymandelic acid: 98 (<6mg)
Metaneprine: 169 (45-290ug)
Normetanephrine: 2807 (85-500ug)
Epinephrine 14 (2-24ug)
Norepinephrine 784 (15-100ug)

Pheochromocytomas are rare catecholamine producing tumors arising

from chromaffin tissue, which causes HTN in association with
nonspecific clinical symptoms that mimic anxiety. Although they are
usually benign, pheochromocytomas often cause the adrenal gland to
make too many hormones

II.

Summary of the case

The following are the basic information about the man:
48 year old man
Have a 1 history of refractory hypertension
Occasional symptoms of panic attacks (hypertension
clinic)
Lab test results for 24 hour urine cathecolamines:
Vanillymandelic acid: 98 (<6mg)
Metaneprine: 169 (45-290ug)
Normetanephrine: 2807 (85-500ug)
Epinephrine 14 (2-24ug)
Norepinephrine 784 (15-100ug)
From the information gathered in the history and examination,
the following differential diagnosis can be posited:
The 48 year old man is suffering from a rare disease called
Pheochromocytoma.

III.

Answers to the guide questions

1. Explain briefly the pathophysiology of Pheochromocytoma

The clinical indicators of a pheochromocytoma result from excessive
catecholamine secretion by the tumor. Secretion may occur either occasionally or
continuously. Catecholamines typically secreted are norepinephrine and
epinephrine; some tumors produce dopamine. The effects of catecholamines are
stimulation of alpha-adrenergic receptors which results in elevated blood pressure,
increased cardiac contractility, glycogenolysis, gluconeogenesis, and intestinal
relaxation and Stimulation of beta-adrenergic receptors results in an increase in
heart rate and contractility.

2. What are the abnormal results? Give the indication of these

results
3. Give the characteristics signs and symptoms of the disease
Symptoms include palpitations, diaphoresis, Abdominal pain, Chest pain,
Irritability, Rapid heart rate, Severe headache, Sweating/Diaphoresis, Weight loss.
Other symptoms that can occur with this disease are Hand tremor, High blood
pressure, and sleeping difficulty.
4. Indication for screening Pheochromocytoma
5. Different tests for diagnosis of Pheochromocytoma.
Screening tests:
Plasma metanephrines
normetanephrines by HPLC (four fold increased)
Diagnostic Test:
24 hour urinary excretion of metanephrines and normetanephrines
(increased levels)
Pharmacologic Tests:
Clonidine Test
Glucagon Stimulation Test

REFERNCES:
Clinical Chemistry Principles, Techniques, and Correlations By Bishop
pages 471-474
Clinical Chemistry Review Handbook by Maria Theresa Rodriguez page
195- 196