Idiopathic
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Metanephrines is more specific test, but VMA would be right too.
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| mjl1717
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1)Epi and NOR :arrow: metanephrine and VMAvia MAO and COMT respectively
2)neural crest origin(adrenal medulla)
3)assoc. with MEN IIa and IIb and von Hippel Lindau
4)sx-HTN,drenching sweat, palpitations,HA.
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| crista
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treatment with which drugs?
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| Idiopathic
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phentolamine/phenoxybenzamine, but must remove surgically.
the key is: NEVER give a B-blocker to a pheo Px, you will send them further into hypertensive crisis (alpha is unopposed).
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| Bela
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Another pneumonic:
Rule of 10s
10% malignant
10% bilateral
10%exta-adrenal
10% calcify
10% kids
10% famililal
Six Ps
Pressure (HTN)
Palpitations
Pain (headache)
Perspiration
Pallor
Penoxybenzamine/Phentylamine
Also, I just read somewhere that this is the only condition in which a frozen section wouldn't help at all b/c a malignant looking specimen can be benign and vice versa. Only upon metastasis would the physician be able to tell something...that's why pheo is usually considered malignant.
p.s. idiopathic, can you please elaborate a bit on the effect of the b blockers and a blockers in these pts.
thnx
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| mjl1717
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I think what Idiopathic is saying is that beta blockade to control tachycardia is added only AFTER alpha blockade has been instituted to prevent unopposed alpha stimulation [Endocrine Secrets by Michael McDermott M.D.]
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| Idiopathic
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Here is the prob: Px comes in with moderate to serious hypertension and tachycardia, so what do you do? Start him/her on a B-blocker to control symptoms. Then in three weeks, when they come back to you in hypertensive crisis, you realize you never considered a pheo., an dthe adrenergics are all out of balance.
Obviously if you know there is a pheo you would not manage this way.
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| almina
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Also a phentalamine test and a glucagon test.
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