1. Department of Internal Diseases, Hypertension and Angiology The Medical University of Warsaw PHAEOCHROMOCYTOMA- Do classical symptoms help in diagnosis? Dorota Kwapisz, Marta Trafalska

2. PHAEOCHROMOCYTOMA   Phaeochromocytomas are catecholamine- producing neuroendocrine tumours arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia   It`s rare tumour with a highly variable clinical presentation

3.   Pts with paroxysmal signs or symptoms suggestive of a pheo The classical triad: headache sweating palpitations …hypertension   asymptomatic pts with an adrenal incidentaloma PHAEOCHROMOCYTOMA

4. PHAEOCHROMOCYTOMA Although the presence of the classical Although the presence of the classical triad of symptoms of pheo may lead to correct diagnosis, yet frequently diagnosis is establised during evaluation of incidentally discovered mass (incidentaloma)

5. THE AIM The aim of the study was: To asses clinical presentation of pheo in recent series of cases, To compare the pts. with pheo in whom the diagnostics was triggered by symptoms (S – ”Symptomatic”) with those in whom diagnostics began with incidental finding of adrenal mass (I – „Incidentaloma”)

6. DESIGN AND METHODS  n= 43 with pheo  mean age 47.4 ± 13.1 yrs  M/F 22/21  n= 29 „symptomatic”, n= 14 „incidentaloma”  n= 39 – pheo was located in the adrenals (1 bilateral – 1S) (1 bilateral – 1S) n= 4 – extraadrenal (1S/3I) n= 4 – extraadrenal (1S/3I)

7. DESIGN AND METHODS „S” SYMPTOMATIC „S” SYMPTOMATIC „I” INCIDENTALOMA „I” INCIDENTALOMA n (pts) n (pts) 29 29 14 14 Mean age 48.45 ± 12.58 yrs 48.45 ± 12.58 yrs 45.21 ± 14.30 yrs 45.21 ± 14.30 yrs M/F 15/14 15/14 7/7 7/7 Malignant 1 1 MEN IIB 1 1

8. METHODS  Incidence of the most typical symptoms of pheo  Duration of hypertension  Urine excretion of metanephrines and catecholamine

9. METHODS   Automatic Blood Pressure Monitoring(ABP)   SpaceLabs 90207   Mean, maximum, SD of 24SBP/24DBP   Echocardiography   Hewlett-Packard 770201   LVMI

10. RESULTS Symptom S+ I S+ I S I p SWEATING 77 % 77 % 90 % 90 % 50 % 50 %<0,022 Headache 73 73 78 78 62 62 Arrhythmias 70 70 83 83 36 36 Palpitations 65 65 86 86 21 21 Anxiety 51 51 59 59 36 36 Pallor 44 44 59 59 14 14 Triad 40 40 52 52 14 14 Hypertension 24 24 22 22 27 27 Weight loss 19 19 21 21 14 14

11. SYMPTOMS S 1. Sweating - 90% 2. Palpitations – 86% 3. Headaches – 78% The triad – 52% The triad – 52% I 1. Headaches – 62% 2. Sweating – 50% 3. Anxiety – 36% The triad – 14%

12. RESULTS – the triad

13. ABP S + I S + I S I 24SBP/24DBP 132/80 ± 16/10 133/79 ± 17/10 131/83 ± 14/10 24HR 79 ± 13 79 ± 14 79 ± 14 78 ± 12 78 ± 12 24SBP/24DBP- day/max 173/107177/107166/108 24SBP/24DBP - night/max 155/ 93 156/ 91 154/ 96 Duration of 5,43 ± 6,26 5,51 5,28 hypertension (yrs) (g/m2) LVMI (g/m2)

15. Metanephrines - mean: S-3790,50 I- 3365,30 p< 0,042 S : 270,8 –23666 I : 1375 – 10729,2

16. RESULTS S+I S I S+I S I Uricacid (mg/dl) 8,03 ± 15,03 9,20 5,38 p< 0,00(0) p< 0,00(0) Urea (mg/dl) 40,78 ± 25,08 41,99 37,90 p< 0,038 p< 0,038 Creatinine (mg/dl) 4,49 ± 22,19 6,17 0,86 p< 0,00(0) p< 0,00(0)

17. CONCLUSIONS   The incidence of classical symptoms may be lower than previously reported   Pheochromocytoma may mimic essential hypertension   Lack of sweating may be misleading and lead to wrong diagnosis