SquarePeg Posted March 5, 2017 Share Posted March 5, 2017 Anyone have experience with diagnosing and/or treating a pt w a pheochromocytoma? If so, would you describe ththe course? 2-8 in a million people... zebras do exist. Link to comment Share on other sites More sharing options...
UGoLong Posted March 5, 2017 Share Posted March 5, 2017 One of our students actually had a pheo! Multiple ED admissions for labile HTN with SBP often in the 220 range. Also headaches and dizziness. Found to have elevated serum metanephrines. CT with contrast found the offending tumor on his adrenal glands on one side. Treated medically with clonidine and other hypertensives until he finished his clinicals, at which time he underwent surgery. I've tested for pheos many times in practice but never found one. Until our 44-year-old male PA student! Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
cbrsmurf Posted March 5, 2017 Share Posted March 5, 2017 I've never seen on in real life. What's the typical course if detected in primary care? ref to endo or neph/uro? then gen surg? Link to comment Share on other sites More sharing options...
greenmood Posted March 7, 2017 Share Posted March 7, 2017 I work in subspecialty surgery. I think we average about a pheo per week here. I'm not involved prior to surgery but I typically see them diagnosed one of two ways. 1) Patient arrives with suggestive symptoms and gets a workup (urine metanephrines and catecholamines), which if positive leads to a diagnostic MRI or PET or 2) Mass is discovered incidentally and workup proceeds from there. Some of the incidental pheos we see are missed diagnostic opportunities (resistant hypertension in young, compliant patients) but most are asymptomatic. To answer the question about referral - you want this patient seen by an endocrinologist with some experience. Once diagnosis is confirmed the patient needs to be on an alpha and beta blockade prior to surgery. We sometimes admit these patients the night before for fluids so they don't go into surgery dry. Link to comment Share on other sites More sharing options...
SquarePeg Posted March 7, 2017 Author Share Posted March 7, 2017 @greenmood - 1 pheo a week?? Wow! Where are you practicing?? Link to comment Share on other sites More sharing options...
greenmood Posted March 7, 2017 Share Posted March 7, 2017 Big academic center. One a week is probably a little ambitious. Maybe 2 a month. We'll go a couple weeks without and then have two in a day. I can't predict it. I'd say about half have either MEN or VHL and have been under surveillance here but we also get a lot of referrals with no family history. Link to comment Share on other sites More sharing options...
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