SymptomsComplaints
This results in an increase in blood pressure, which either remains at a relatively constant level or is accompanied by highs (blood pressure peaks) and lows. Especially when the blood pressure rises, the patient complains: Other important symptoms are pale skin and weight loss! An increased number of white blood cells can be detected in the blood count. If the face is reddened and weight has increased, this speaks against the diagnosis of pheochromocytoma.
- Headaches
- Sweating
- Palpitations
- Trembling (Tremor)
Diagnosis
The diagnosis is made on the one hand on the basis of the clinic (symptoms-complaints) and on the other hand on the basis of laboratory tests and imaging diagnostics (MRTCT). In addition to the symptoms mentioned above (headaches, palpitations, facial pallor), the physician can also make the following findings: In the 24h – blood pressure measurement, the physiologically actually existing blood pressure reduction overnight is missing. A measurement of the hormones that are typically produced by pheochromocytomas takes place.
It can be measured either in urine or in blood. In 24-hour urine, either the hormones themselves or their breakdown products (e.g. vanellin mandelic acid) are measured. Values above 200 ng/l have disease value, as long as the hormones are below a value of 50 ng/l, they are considered normal.
In the blood, values above 2000 ng/l are considered pathological (diseased), values below 500 ng/l are normal. Subsequently, if pheochromocytoma is suspected, the hormone dopamine can also be determined. (Dopamine is usually only produced by malignant tumors of this type – apart from the body’s regular dopamine production, of course).To get a confirmation of the diagnosis, a confirmatory test is performed.
For this purpose, the patient is administered clonidine, a centrally acting agent against high blood pressure. Normally the concentration of catecholamines (adrenaline and noradrenaline) in the blood drops. However, this does not happen in the case of autonomous catecholamine serotonin release as a result of a pheochromocytoma.
A comparative measurement between the amount of hormones in daytime urine and the amount in nighttime urine (after administration of clonidine) also contributes to the diagnosis. At night, urine normally shows a strong decrease of catecholamines in healthy patients, but also in patients with primary hypertension (high blood pressure not caused by another disease). If this is not the case, a pheochromocytoma is present. Localization of the pheochromocytoma is possible by imaging diagnostics such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI).
