Pheochromocytoma physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2] Mohammed Abdelwahed M.D[3]
Overview
Common physical exam findings of pheochromocytoma include tachycardia, hypertension, and orthostatic hypotension.
Physical Examination
Appearance of the Patient
- Patients may appear tired, weak, diaphoretic and anxious.[1]
- Patients may appear quite well if the disease is asymptomatic.
- Patients may appear flushed due to associated increase in erythropoietin secretion.[2]
- Patients may appear obese due to associated type2 diabetes mellitus and Cushing's syndrome.[3]
Vital Signs
- Tachycardia with a regular pulse. Irregular pulse may occurr in supraventricular tachycardia.
- Tachypnea if malignant secondaries are found in the lung. Dyspnea occurs in patients with complicated heart failure and cardiomyopathy.
- Rapid strong equal pulse.
- High blood pressure with normal pulse pressure.
- Hypotension occurs due to fluid contraction.
Skin
- Jaundice secondary to deranged liver function in case of metastasis to the liver.
Head
- Facial flushing.
- Scleral icterus in case of metastasis to the liver.
- MEN2 patients associated with mucosal neuromas show multiple lips and tongue neuromas.
Neck
- Congested neck veins in patients with cardiomyopathy.[4]
- Painless lymphadenopathy if malignant secondaries found in the neck (rapid increase in the size of the node. Prevalence of malignancy in lymph node biopsies performed is 60%.[5]
- Thyromegaly/thyroid nodules if MEN patients due to medullary thyroid cancer.[6]
Lungs
- Asymmetric chest expansion / decreased chest expansion if malignant secondaries are found in the lung.
Heart
- Chest tenderness upon palpation in MEN1 patients due to hyperparathyroidism.
- Palpation: Precordial heave especially at apex due to left ventricular hypertrophy in long standing patients.
- Auscultation: normal S1 and accentuated S2 due to high systemic resistance.
Abdomen
- Abdominal distention in patients with primary hyperparathyroidism associated constipation or Hirschsprung disease.
- Abdominal tenderness in the lower abdominal quadrants in MEN2 patients with Hirschsprung disease.[7]
- A palpable abdominal mass in the lower abdominal quadrant.
- Guarding may be present.
- Hepatomegaly if malignant secondaries found in liver.
- Diarrhea caused by gastrointestinal secretion of fluid and electrolytes, and flushing in medullary thyroid cancer patients.[8]
Back
- Point tenderness in MEN1 patients with hyperparathyroidism.
References
- ↑ Bravo EL, Gifford RW (1993). "Pheochromocytoma". Endocrinol Metab Clin North Am. 22 (2): 329–41. PMID 8325290.
- ↑ Drénou B, Le Tulzo Y, Caulet-Maugendre S, Le Guerrier A, Leclercq C, Guilhem I; et al. (1995). "Pheochromocytoma and secondary erythrocytosis: role of tumour erythropoietin secretion". Nouv Rev Fr Hematol. 37 (3): 197–9. PMID 7567437.
- ↑ La Batide-Alanore A, Chatellier G, Plouin PF (2003). "Diabetes as a marker of pheochromocytoma in hypertensive patients". J Hypertens. 21 (9): 1703–7. doi:10.1097/01.hjh.0000084729.53355.ce. PMID 12923403.
- ↑ Kassim TA, Clarke DD, Mai VQ, Clyde PW, Mohamed Shakir KM (2008). "Catecholamine-induced cardiomyopathy". Endocr Pract. 14 (9): 1137–49. doi:10.4158/EP.14.9.1137. PMID 19158054.
- ↑ HEINRICH WA, JUDD ES (1948). "A critical analysis of biopsy of lymph nodes". Proc Staff Meet Mayo Clin. 23 (21): 465–9. PMID 18888946.
- ↑ Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF; et al. (2015). "Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma". Thyroid. 25 (6): 567–610. doi:10.1089/thy.2014.0335. PMC 4490627. PMID 25810047.
- ↑ O'Riordain DS, O'Brien T, Crotty TB, Gharib H, Grant CS, van Heerden JA (1995). "Multiple endocrine neoplasia type 2B: more than an endocrine disorder". Surgery. 118 (6): 936–42. PMID 7491537.
- ↑ Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF; et al. (2015). "Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma". Thyroid. 25 (6): 567–610. doi:10.1089/thy.2014.0335. PMC 4490627. PMID 25810047.