The signs and symptoms of a<unk>  are those related to sympathetic nervous system hyperactivity. The classic triad includes headaches (likely related to elevated blood pressure, or hypertension), tachycardia/elevated heart rate, and diaphoresis (excessive sweating, particularly at night, also known as hyperhidrosis). However, patients are unlikely to experience continuous symptoms. Due to the paroxysmal nature of catecholamine synthesis and release, patients may experience "attacks" or "spells" where they are suddenly overwhelmed with signs and symptoms of their tumor. Attacks can occur spontaneously (without warning) or may be triggered by a variety of pharmaceutical agents, foods, intraoperative tumor manipulation, intubation, or during anesthetic induction. medulla (center, red) is the origin of the adrenal gland +Lifestyle, Medication, and Diet-Induced Catecholamine Surges Lifestyle Medications Diet Physical Exertion Histamine Cheese Anxiety/Stress Metoclopramide Fermented wine/beer Trauma/Pain Glucagon Tomatoes Micturition ACTH Coffee/Beans There are two adrenal glands, highlighted in yellow, on top of each of the kidneys While the above symptoms are classic, other common clinical manifestations have been reported and include (in no particular order) * Pallor * Heat intolerance * Weight loss * Chest and/or Abdominal Discomfort * Nausea/Vomiting * Constipation * Orthostatic Hypotension * Medically defined as a decrease in systolic blood pressure (top number) of 20 mm Hg or diastolic blood pressure (bottom number) of 10 mm Hg after a change in position from lying down or sitting to a standing position * Feeling of becoming light-headed or dizzy after swiftly changing positions * Psychiatric Manifestations * Anxiety, Panic Attacks, Nervousness, Tremulousness * Hyperglycemia (high blood sugar) Complications While the symptoms of a<unk>  are quite common, the disease has been referred to as "the great mimic". Literature reports that just 0.1% of patients with hypertension are diagnosed with this rare endocrine disorder and symptomatic patients are often mistaken for much more common diseases. As symptoms are often paroxysmal (episodic/sporadic), patients may not immediately seek treatment as the problem "disappears on its own." Furthermore, when pictured in the ideal clinical scenario (an older woman in her mid-50s), the spontaneous attacks of flushing, sweating, and a racing heart may be mistaken for pre-menopausal related hot-flashes. Unmanaged<unk>  is dangerous and can lead to serious complications, including death. The cardiovascular system is the most commonly involved. In pregnancy,<unk>  is associated with significant maternal and fetal mortality, mainly due to hypertensive crisis in the mother and intrauterine growth restriction in the fetus. Cardiovascular system # Hypertensive crisis:<unk> -related hypertensive emergencies are one of the most feared clinical manifestations. Attacks are random and may occur secondary to a trigger (see Signs and Symptoms above) or spontaneously after a catecholamine surge. The prevailing symptom is elevated systolic blood pressure (> 200 mmHg) that is unresponsive to traditional treatment regimens and threatens end-organ damage. Patients require immediate, life-saving treatment to prevent further damage to other organs and/or death. # Myocardial Ischemia/Infarction: A heart attack is often caused by a significant build-up of plaque (atherosclerosis) in the coronary vessels. Patients with<unk>  present with myocardial infarctions despite an overall lack of plaque build-up, indicating a different mechanism for the myocardial infarction. Current research hypothesizes that the tumor secretes massive amounts of catecholamines, which directly interact with myocardial (heart) tissue and exert negative effects including oxygen deprivation, leading to accelerated scarring and cell death. # Toxic Myocarditis: Even in patients without myocardial damage, excessive catecholamines can result in abnormal ST changes on an ECG. Norepinephrine (a catecholamine) is hypothesized to result in damaged cardiac tissue by inhibiting coronary blood flow and depriving cells of oxygen, thus resulting in ischemic tissue. Fortunately, following tumor excision and the subsequent quelling of catecholamines, the damage has been proven reversible. # Cardiomyopathy:<unk> s have been implicated in various types of cardiomyopathy, including (myocarditis, see above), dilated cardiomyopathy, and stress-induced or Takotsubo cardiomyopathy. As with the other cardiovascular-related complications, excess catecholamines are responsible for the increased myocardial burden and significant physiologic stress. Current literature indicates that most of the catecholamine-induced damage is reversible, thereby strengthening the argument for early and accurate diagnosis in order to allow for cardiac remodeling and prevent further destruction. # Arrhythmias: Sinus tachycardia is the most common abnormal heart rhythm associated with a<unk>  and is experienced by patients as the feeling of a "fluttering heart" or palpitations. Many other tachyarrhythmias (fast heart rate) have also been reported. Nervous system # Cerebrovascular Accident (Stroke): Multiple reports have detailed transient ischemic attacks or strokes in patients with a<unk> . In a study of 130 patients with<unk> , 7 patients were diagnosed with a transient ischemic attack (the neurologic deficit completely resolved) and 3 patients experienced a stroke with persistent symptoms. # Headache: Headaches are one of the core clinical manifestations of a<unk>  and can result in debilitating pain. The majority of studied patients report their pain began and ended abruptly without warning and described the pain as a severe, bilateral throbbing (although the scale of severity was not published). While 71% of the studied patients reported headaches, just over 20% of the affected patients endorsed associated nausea, vomiting, photophobia, or phonophobia, which are typically associated with migraines. Urinary system # Acute Renal Failure: Several reports have detailed rhabdomyolysis (rapid skeletal muscle breakdown) leading to acute kidney injury and the need for transient dialysis in the undiagnosed<unk>  patient as their primary presenting symptom. Kidney failure is brought about by catecholamine-induced muscle injury. Norepinephrine causes vessels to narrow, thereby limiting blood flow and inducing ischemia. Multiple organ dysfunction syndrome (MODS): Caused by an elevated inflammatory response, multiple organ dysfunction is a severe, life-threatening emergency with increasing mortality based on the number of systems involved.<unk> -related MODS is associated with multiple organ failure, hyperthermia > 40 degrees Celsius, neurologic manifestations, and cardiovascular instability resulting in either hypo or hypertension. In contrast to a hypertensive crisis,<unk> -associated MODS may not respond to traditional alpha-receptor agents and may require emergent surgical excision if clinical stability is not achieved.
Pheochromocytoma
Renal oncocytoma
Histiocytoma
Pineocytoma
Pituitary adenoma
Mastocytoma
Adrenocortical adenoma
Glomus tumor