Pheochromocytoma is a tumor located in the brain substance or gland tissues. It grows under the influence of hormones. Only in 10% of cases it is outside the adrenal glands, most often has a two-sided nature. At present, this tumor is recognized as one of the least studied.
The concept of
Education itself distinguishes catecholamines( noradrenaline and adrenaline).This leads to the appearance of specific symptoms.
This tumor is surrounded by a capsule and is well supplied with blood. Its dimensions may be small or increase to 15 cm in diameter. Usually it grows in size by 3-7 mm. Despite the fact that in 9 cases out of 10, education consists of benign cells, sometimes malignant cells are also found.
The ICD-10 code is D35, indicating the neoplasm of other and unspecified endocrine glands.
This tumor is sometimes combined with neurofibromatosis. Then the disease is assigned a separate code.
Causes of pathology
The etiology of appearance is not fully understood. Presumably occurs due to two main causes:
- of heredity,
- of multiple endocrine neoplasia.
In the first case we are talking about mutations that are in the relatives of patients. Usually in this case the gene that is responsible for the proper functioning of the adrenal glands is transformed.
Multiple neoplasia 2A and 2B type is also a hereditary disease characterized by proliferation of endocrine gland cells.
With these problems, the lesion affects not only the adrenal glands, but also the thyroid and parathyroid glands, mucous membranes, the musculoskeletal system.
Clinical symptoms of pheochromocytoma
The main symptom is hypertension. It can be episodic or permanent. In the first case, stress can become a prerequisite, increased physical load. Often the increased pressure is sharply replaced by a decreased one.
During the exacerbation,
- abdominal pain,
- increased sweating,
- pulsating pain in the head,
- pallor of the dermis,
- nausea and vomiting.
There are bouts of anxiety, a constant need for coffee. This is due to the fact that a large amount of adrenaline stimulates the process of excitation of the cells of the brain and spinal cord. There is an increase in the transmission of impulses from the nervous system to the organs.
As the swelling in the blood rises, ESR increases, signs of heart failure, violations of the vessels of the fundus are evident.
Elevated blood pressure may become a prerequisite for retinal detachment, as well as for hemorrhage.
There is also a decrease in weight due to a significant increase in metabolism. Weight loss on average reaches 10 kg without changing the diet.
Diagnosis of adrenal pheochromocytoma
The study is based on the analysis and the use of radiation methods. The latter allows you to visualize the tumor. In this study of blood on the number of hormones can establish excessive production of them.
For laboratory diagnosis of pheochromocytoma, 24-hour urine is collected and a test is performed. By the amount of metanephrine, you can more accurately determine the level of adrenaline and norepinephrine. It is possible to carry out such a study on the blood, but the possibility of an error is not ruled out.
Radiation methods include computed tomography with the introduction of contrast fluid. Thanks to this, doctors determine the nature of the tumor. Malignant formations have a high density, actively accumulate contrast.
Benign however have completely opposite signs. For clarity, we use isotope scanning. But this method is used in exceptional cases.
Treatment of a tumor
Treatment of an adrenal pheochromocytoma involves surgical removal. But before him the patient is trained. It consists in the use of medications aimed at reducing the crisis.
If this is not done, serious complications and death of the patient may occur during manipulation.
For preparation, a doxazosin-based drug is often used. The drug is prescribed approximately two weeks before the operation.
The operation itself is performed by different methods, depending on the size and location of the tumor. Applicable methods:
The traditional way is to get open access. It is relevant when the location of the tumor is not known or both adrenal glands are affected. Laparoscopy is less traumatic. Recovery after it takes no more than 3-5 days.
Emergency care for hypertensive crisis
Independence of the features of pheochromocytoma cells is often accompanied by hypertensive crisis. There are several rules, compliance with which will ease the patient's condition and wait for emergency care.
It is necessary to lay the patient, creating a situation of tranquility. Then:
- is injected with drugs that reduce blood pressure,
- pressure values are checked every 15 minutes,
- often develops non-selective beta-adrenergic blockers in the development of tachycardia.
Additionally, try to restore the patient's breathing. To do this, you need to take a deep breath and exhale. Help and distracting procedures: the use of cooling dressings on the head, the use of hot baths for the feet.
Life expectancy of patients
Active release of hormones is a direct toxic effect on the heart, which can cause damage to the body cells.
Video shows CT scan of adrenal pheochromocytoma: