Pheochromocytoma

The pheochromocytoma is a hormonal and active tumor of adrenal glands. It is located in marrow or hromaffinovy fabric of gland and it is considered one of the most few studied endocrinological pathologies.

Many aspects of an etiology and development of a pheochromocytoma of adrenal glands are still unknown to modern medicine. The family form of a pheochromocytoma is characteristic of people with hereditary diseases: Reklingauzen's disease (he is a neurofibromatosis), Sippl or Hippelya-Lindau's syndrome.

The pheochromocytoma occurs on average at 1 of 10 thousand people. Among the people suffering from a hypertension, the frequency of a disease makes 1%, i.e. already 1 person on 100 patients with the increased arterial pressure.

Difficulty of diagnosis of a pheochromocytoma of adrenal glands consists in quite often asymptomatic course of a disease or in a wide range of clinical symptoms of a pheochromocytoma. So according to the American physicians the correct diagnosis at patients with a pheochromocytoma is established only in 37-40% of cases.

As a rule, the pheochromocytoma of an adrenal gland is located in one of glands. Defeat by a tumor of both pair bodies or localization of a pheochromocytoma out of area of adrenal glands is diagnosed only at 10-15% of diseases.

And in 10% of cases of pathology malignant symptoms of a pheochromocytoma – innidiation of a tumor in lymph nodes, bones, muscles, a liver are found, is more rare - in lungs and a brain.

Symptoms of a pheochromocytoma of adrenal glands

One of the main symptoms of a pheochromocytoma is hypertensia. The patient can have an incidental supertension or constant. In the first case attacks of hypertensia are provoked by emotional experiences, the raised exercise stress or an overeating.

During an attack of hypertensia carry to pheochromocytoma symptoms:

• headache of the pulsing character,
• nausea,
• vomiting,
• pallor of integuments,
• perspiration,
• discomfort in a breast and a stomach,
• myotonia of shins.

After an attack at the patient total disappearance of all symptoms of a pheochromocytoma, a sharp lowering of arterial pressure up to cardinally opposite state is observed – hypotensions.

Differential diagnosis of a pheochromocytoma has to be carried out at people with complaints on:

• alarm attacks,
• hyperventilation syndrome,
• inflows during a menopause,
• the increased need for caffeine,
• spasms,
• short-term loss of consciousness.

Distinguish signs of psychological, cardiovascular, endocrine exchange, hematologic and gastrointestinal frustration from symptoms of a pheochromocytoma of the complicated form:

• psychoses,
• neurasthenia,
• heart failure,
• defeats of vessels of kidneys and eyeground,
• hyperglycemia (the increased content of glucose in blood),
• hypogonadism (deficit of hormones androgens in an organism),
• increase in erythrocytes or SOE of blood,
• hypersalivation, etc.

Diagnosis of a pheochromocytoma of adrenal glands

Clinical symptom of a pheochromocytoma is existence in tissues of an urinary system, adrenal glands and bronchial tubes of catecholamines. These specific substances produce katekholaminprodutsiruyushchy fabrics of a tumor. Granules of catecholamines in diagnosis of a pheochromocytoma can be found, having applied a silvering method according to Gamperlyu-Masson and across Grimelius.

Also assessment of secretion of catecholamines in a daily portion of urine is the cornerstone of laboratory diagnosis of a pheochromocytoma. Besides, in the patient's urine adrenaline and vanililmindalny acid quite often are found.

The second stage of diagnosis of a pheochromocytoma of adrenal glands – studying of features of fluctuations of arterial pressure of the patient. Increase in the general vascular resistance and decrease in volumes of blood, as a rule, is found in patients with this type of a hormonal and dependent tumor.

Obligatory stage of diagnosis of a pheochromocytoma is control of cordial activity. Development of a cardiomyopathy and permanent disturbance of a cordial rhythm is considered a characteristic symptom of a pheochromocytoma.

After the clinical and laboratory trials topical diagnosis of a pheochromocytoma – a stsintigrafiya with radioactive material metaiodbenzylguanidine is carried out. Effective diagnostic methods of a pheochromocytoma from 90-100% sensitivity to a tumor are also MPT and KT.

Use of ultrasonography in diagnosis of a pheochromocytoma is justified only in the presence of a tumor more than 2 cm. The angiography in diagnosis of a pheochromocytoma is applied seldom in connection with labor input of a method and high risk of complications.

Treatment of a pheochromocytoma of adrenal glands

The most radical method of treatment of a pheochromocytoma – a surgical oncotomy. However it can be carried out only after stabilization of arterial pressure.

For this purpose at a presurgical stage of treatment of a pheochromocytoma to the patient reception and - adrenoblockers is appointed: Phenoxybenzamine, Phentolamine, Tropaphenum, etc. Emergence of the orthostatic fluctuations of arterial pressure caused by a body postural change is considered criterion of efficiency of treatment of a pheochromocytoma.

The choice of a method of surgical treatment of a pheochromocytoma depends on features of a tumor. The good manipulation during operation is provided transperitoneal, transthoracic, extra peritoneal or the combined accesses for an operative measure.

At single tumors efficiency of surgical treatment of a pheochromocytoma high. The recurrence of a disease is observed only in 12-15% of cases.

In certain cases after an oncotomy the patient has no decrease pressure. Such postoperative complication is connected with injury of a renal artery or an incomplete oncotomy.

At multiple tumors of the uniform standard in surgical treatment of a pheochromocytoma does not exist. Full removal of all tumors is considered expedient, however because of high risk of operation from this tactics of treatment of a pheochromocytoma it is necessary to refuse and carry out a resection of tumors in several steps or to delete only a part of a tumor.

Conservative treatment of a pheochromocytoma of adrenal glands is less effective. It is directed to decrease in an organism of level of catecholamines by drugs on the basis of A-metiltirozinoma. Conservative treatment of a pheochromocytoma is capable of 80% to reduce quantity of catecholamines and to prevent development of hypertensive crisis. However systematic reception A-metiltirozinoma can lead to disturbances of mentality and functional disorders of a GIT.