Pheochromocytoma - Disease that Can Stimulate Many Different Syndromes

Abstract

Pheochromocytoma is a rare but important tumour of chromaffin cells. Clinical and biochemical manifestation are mainly caused by excess of circulating catecholamines and hypertension. Manifestations mimics many conditions, which may result in erroneous diagnoses and improper treatment. Most pheochromocytomas are sporadic and up to 25 percent are hereditary. Pheochromocytoma can be a component of multiple endocrine neoplasia type 2 (MEN-2), von Hippel-Lindau disease, familial paragangliomas syndrome and neurofibromatosis type 1. Diagnosis of pheochromocytoma depends on biochemical evidence of catecholamine production by the tumor. Recent findings have demonstrated high sensitivity of plasma and urinary levels of metanephrines for detecting pheochromocytoma. An algorithm for clinical diagnostic steps is presented. Surgical resection by laparoscopic or open adrenalectomy can be curative. Drug treatment prior to and during surgery is mandatory. Lifelong follow-up after surgical removal of pheochromocytoma is recommended. Routine analysis for mutations of susceptibility genes for pheochromocytoma is indicated to identify pheochromocytoma-associated syndromes.