From the Guidelines
Physical exam findings of pheochromocytoma primarily reflect the effects of excessive catecholamine secretion, and patients often present with hypertension, tachycardia, pallor, flushing, or diaphoresis during hypertensive episodes, as well as orthostatic hypotension and skin stigmata of neurofibromatosis 1. The physical examination of patients with pheochromocytoma may reveal a range of findings, including:
- Hypertension, which may be persistent or paroxysmal
- Tachycardia
- Pallor, flushing, or diaphoresis during hypertensive episodes
- Orthostatic hypotension
- Skin stigmata of neurofibromatosis, such as café-au-lait spots or neurofibromas
- Abdominal masses, although these are rare and usually only palpable if the tumor is large
- Retinal changes consistent with hypertension, such as arteriovenous nicking or papilledema, may be visible on fundoscopic examination These findings result from the tumor's release of epinephrine and norepinephrine, which activate alpha and beta-adrenergic receptors throughout the body, affecting cardiovascular function, metabolism, and the sympathetic nervous system 1. It's essential to note that physical exam findings can be intermittent, as catecholamine release often occurs in episodes, and some patients may appear completely normal between attacks. A thorough physical examination, combined with a detailed medical history and appropriate diagnostic testing, is crucial for diagnosing pheochromocytoma and initiating prompt treatment to prevent morbidity and mortality.
From the Research
Physical Exam Findings of Pheochromocytoma
The physical exam findings of pheochromocytoma are primarily related to the effects of excess catecholamines on the body. Some common findings include:
- Sustained or paroxysmal hypertension 2, 3, 4
- Severe headaches 2, 3
- Palpitations 2, 3
- Sweating 2, 3
- Orthostatic hypotension in some cases 4
- Cardiovascular involvement secondary to catecholamine hypersecretion 5
Clinical Manifestations
Pheochromocytomas can present with a wide range of clinical manifestations, including:
- Hypertensive crisis 3, 4
- Cardiac complications 3
- Hypotension or shock 3
- Sudden death 3
- Asymptomatic cases in some individuals 4
Diagnostic Considerations
The diagnosis of pheochromocytoma depends on the demonstration of catecholamine excess and localization of the tumor using imaging techniques 2, 5. A genetic study is also recommended to identify hereditary disorders that may be present in more than 30% of cases 5.