A 32 year old man with anxiety is referred to clinic by his GP. On examination you find an elevated blood pressure and notice his lower legs appear mottled. His pulse is 140 bpm. Testing of his urine would most likely demonstrate raised levels of which of the following metabolites?
The patients features suggests he may have a pheochromocytoma.
The patients features suggests he may have a pheochromocytoma.
Pheochromocytoma
A pheochromocytoma is a catecholamine-secreting tumor of chromaffin cells typically located in the adrenal glands.
Features include:-
- Hypertension
- Tachycardia
- Diaphoresis
- Livedo reticularis (mottled skin)
- Postural hypotension
- Tachypnea
- Cold and clammy skin
- Severe headache
- Angina
- Palpitations
- Nausea
- Vomiting
It is diagnosed by measuring catecholamine products in the blood or urine. The principal urinary metabolic products of epinephrine and norepinephrine are the metanephrines vanillylmandelic acid (VMA) and homovanillic acid (HVA). Healthy people excrete only very small amounts of these substances.
