Arterial hypertension with pheochromocytoma occurs in half of patients, and half of these cases have hypertensive crises. In addition, the suspicion that the cause of high blood pressure is precisely the hormonal tumor of the adrenal glands, should arise in the attending physician, if the medicamental treatment of hypertension of the patient does not bring a good result. If you conduct a survey of this category of patients, then the tumor of the adrenal gland is found in every tenth case. However, the constant hypertension with pheochromocytoma is a rare phenomenon, most often unstable pharmacological uncontrolled oscillations are observed. This situation is caused by a reduced volume of circulating blood and a strong suppression of sympathetic reflexes.
The symptomatology of the hypertensive crisis with pheochromocytoma does not differ from the usual manifestations for high blood pressure, such as increased heart rate( HR), headaches, and increased sweating. The frequency of seizures varies from patient to patient and can range from one in a few months to 30 per day, but these are extremes. The main frequency of negative manifestations of pheochromocytoma occurs once a week. Pheochromocytoma crises tend to increase with time, but their severity does not change. In general, such pressure drops last about an hour, and only in very rare cases their duration can reach a week. The rate of increase in arterial hypertension during an attack is quite rapid, but the symptoms subsiding after the crisis peak is slow.
Increased arterial hypertension is accompanied by increased heart rate, lack of oxygen, sweating of feet and hands, pallor of the face, cold extremities. At the same time, there is a narrowing of the vessels, which increases the pressure rise. In addition, spasm of blood vessels leads to an acceleration of metabolism and a decrease in heat loss, and as a result, increased sweating and fever. During an attack lasting several hours, patients often experience severe nausea, vomiting, abdominal and chest pain, convulsions, blurred vision, paresthesia.
Hypertensive seizures can be caused by such diverse factors as violations of defecation and urination, hyperventilation, Valsalva tests, severe sneezing, sexual intercourse, sudden change of posture, physical activity and other actions that cause pressure in the site of pheochromocytoma localization. So the crisis can be caused by the use of β-adrenoblockers, morphine, nicotine, metoclopramide, phenothiazine derivatives, surgical interventions, childbirth, intubation of the trachea, anesthesia, reception of droperiodol, angiography, alcoholic beverages, wine, beer and cheese.
Arterial hypertension is an accompanying pheochromocytoma, because the tumor releases into the blood such catecholamines as epinephrine and noradrenaline, which simultaneously lower the tone of the vessels and increase myocardial contractility, because of this crises can cause ischemic and hemorrhagic stroke, shock, myocardial infarction, cerebral vascular embolism, pulmonary edema. Sometimes after another sharp jump in pressure, hemorrhagic necrosis of the tumor can develop. When, after hypertension, hypotension occurs with a fall in the level of catecholamines, there will be venous and arterial dilatation, which will cause sudden death.
Drug treatment can reduce the negative consequences of the crisis itself and somewhat stabilize arterial hypertension, thereby reducing the risk of stroke and other consequences of an attack, and finally solve the problem with pressure surges only after surgical removal of the tumor.