Skip to main content

Advertisement

SpringerLink
Log in

Hypertension in patients with pheochromocytoma

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Adrenal-dependent hypertension syndromes are uncommon forms of hypertension. They include primary aldosteronism, pheochromocytoma, Cushing’s syndrome, and congenital adrenal hyperplasia. Pheochromocytomas are the cause of hypertension in 0.1% to 0.2% of hypertensive patients. Excess catecholamine release and other neural and humoral mechanisms contribute to the pathophysiology of hypertension. Patients with pheochromocytomas have a potentially curable cause of endocrine hypertension and, if undetected, pheochromocytomas confer a high risk for morbidity and mortality, especially during surgical procedures and pregnancy. All patients with incidental adrenal tumors, regardless of tumor size, should be biochemically screened for pheochromocytoma (especially before resection or needle biopsy) to avoid precipitation of a lethal hypertensive crisis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Cook DM, Loriaux DL: The incidental adrenal mass Am J Med 1996, 101:88–94.

    Article  PubMed  CAS  Google Scholar 

  2. Tutuncu NB, Gedik O: Adrenal incidentaloma: report of 33 cases. J Surg Oncol 1999, 70:247–250.

    Article  PubMed  CAS  Google Scholar 

  3. Proye C, Jafari Manjili M, Combemale F, et al.: Experience gained from operation of 103 adrenal incidentalomas. Arch Surg 1998, 383:330–333.

    Article  CAS  Google Scholar 

  4. Caty MG, Coran AG, Geagen M, et al.: Current diagnosis and treatment of pheochromocytoma in children. Experience with 22 consecutive tumors in 14 patients. Arch Surg 1990, 125:978–981.

    PubMed  CAS  Google Scholar 

  5. Stackpole RH, Melicow MM, Uson AC: Pheochromocytoma in children: report of nine cases and review of the first 100 published cases with follow-up studies. J Pediatr 1963, 63:315.

    Article  Google Scholar 

  6. Chen H, Doppman JL, Chrousos GP, et al.: Adrenocorticotropic hormone-secreting pheochromocytomas: the exception to the rule. Surgery 1995, 118:988–995.

    Article  PubMed  CAS  Google Scholar 

  7. Herrera MF, Stone E, Deitel M, et al.: Pheochromocytoma producing multiple vasoactive peptides. Arch Surg 1992, 127:105–108.

    PubMed  CAS  Google Scholar 

  8. Werbel SS, Ober KP: Pheochromocytoma. Update on diagnosis, localization, and management. Med Clin North Am 1995, 79:131–153.

    PubMed  CAS  Google Scholar 

  9. Brav EL, Tarazi RC, Fouad FM, et al.: Blood pressure regulation in pheochromocytoma. Hypertension 1982, 4(3 pt 2):193–199.

    Google Scholar 

  10. Brav EL: Pheochromocytoma: new concepts and future trends. Kidney Int 1991, 40:544–556.

    Article  Google Scholar 

  11. Brav EL: Evolving concepts in the pathophysiology, diagnosis, and treatment of pheochromocytoma. Endocr Rev 1994, 15:356–368. This paper provides a comprehensive review of the clinical presentation, biochemical diagnosis, and management of patients with pheochromocytoma. The author emphasizes the need for early diagnosis to cure hypertension and avoid the lethal complications of unrecognized pheochromocytoma.

    Google Scholar 

  12. Oishi S, Sato T: Plasma renin activity, aldosterone and catecholamines in phaeochromocytoma: effect of converting enzyme inhibition. J Hum Hyperten 1994, 8:923–924.

    CAS  Google Scholar 

  13. Plouin PF, Chatellier G, Rougeot MA, et al.: Plasma renin activity in phaeochromocytoma: effects of beta-blockade and converting enzyme inhibition. J Hypertens 1988, 6:579–585.

    Article  PubMed  CAS  Google Scholar 

  14. Donckier JE, Michel LA, Collard E, et al.: Plasma atrial natriuretic factor and catecholamines before and during excision of pheochromocytoma. Acta Chir Belg 1991, 91:112–116.

    PubMed  CAS  Google Scholar 

  15. Stepniakowski K, Januszewicz A, Lapinski M, et al.: Plasma atrial natriuretic peptide (ANP) concentration in patients with pheochromocytoma. Blood Press 1992, 1:157–161.

    Article  PubMed  CAS  Google Scholar 

  16. Kitamura K, Kangawa K, Kawamoto M, et al.: Adrenomedullin: a novel hypotensive peptide isolated from human pheochromocytoma. Biochem Biophys Res Commun 1993, 192:553–560.

    Article  PubMed  CAS  Google Scholar 

  17. Nishikimi T, Kitamura K, Saito Y, et al.: Clinical studies on the sites of production and clearance of circulating adrenomedullin in human subjects. Hypertension 1994, 24:600–604.

    PubMed  CAS  Google Scholar 

  18. Levenson JA, Safar ME, London GM, et al.: Haemodynamics in patients with phaeochromocytoma. Clin Sci 1980, 58:349–356.

    PubMed  CAS  Google Scholar 

  19. Smithwick RH, Greer NER, Robertson CW, et al.: Pheochromocytoma; a discussion of symptoms, signs and procedures of diagnostic value. N Engl J Med 1950, 242:252–257.

    Article  PubMed  CAS  Google Scholar 

  20. Smithwick RH: The surgical physiology of hypertension. Surg Clin North Am 1949, 29:1699–1730.

    PubMed  CAS  Google Scholar 

  21. Streeten DH, Anderson GH Jr: Mechanisms of orthostatic hypotension and tachycardia in patients with pheochromocytoma. Am J Hypertens 1996, 9:760–769. This paper explores the pathophysiologic mechanisms of orthostatic hypotension and orthostatic tachycardia in 18 patients with subsequently proven pheochromocytoma. Blood pressure, heart rate, plasma catecholamine measurements, and measurements of venous contractile responses to infused norepinephrine were used to indicate decreased responsiveness of the vasculature to norepinephrine, probably resulting from downregulation of a-adrenergic receptors.

    Article  PubMed  CAS  Google Scholar 

  22. Crout JR, Sjoerdsma A: Turnover and metabolism of catecholamines in patients with pheochromocytoma. J Clin Invest 1964, 43:92–94.

    Article  Google Scholar 

  23. Wocial B, Januszewicz W: Urinary excretion of catecholamines and their metabolites in patients with pheochromocytoma. Ann Endocrinol (Paris) 1974, 35:237–246.

    CAS  Google Scholar 

  24. Platts JK, Drew PJ, Harvey JN: Death from phaeochromocytoma: lessons from a post-mortem survey. J R Coll Physicians Lond 1995, 29:299–306.

    PubMed  CAS  Google Scholar 

  25. Sutton MG, Sheps SG, Lie JT: Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc 1981, 56:354–360.

    PubMed  CAS  Google Scholar 

  26. O’Riordain DS, Young WF Jr, Grant CS, et al.: Clinical spectrum and outcome of functional extra-adrenal paraganglioma. World J Surg 1996, 20:916–22. This paper discusses evolving concepts in diagnosis, treatment, clinical spectrum, and outcome in 66 patients with extra-adrenal paraganglioma. Of note, 22% of patients had multiple tumors and 21% had metastatic disease, and patients who were cured with initial surgery had an 18% recurrence rate.

    Article  PubMed  Google Scholar 

  27. Carney JA: The triad of gastric epithelioid leiomyosarcoma, pulmonary chondroma, and functioning extra-adrenal paraganglioma: a five-year review. Medicine (Baltimore) 1983, 62:159–169.

    CAS  Google Scholar 

  28. Whalen RK, Althausen AF, Daniels GH: Extra-adrenal pheochromocytoma. J Urol 1992, 147:1–10.

    PubMed  CAS  Google Scholar 

  29. Modigliani E, Vasen HM, Raue K, et al.: Pheochromocytoma in multiple endocrine neoplasia type 2: European study. The Euromen Study Group. J Intern Med 1995, 238:363–367. This retrospective review studied the main characteristics of pheochromocytoma in 300 patients with multiple endocrine neoplasia syndrome. Pheochromocytomas were the presenting feature in approximately 25% of cases and were associated with a malignancy rate of only 4%. Of the 39 deaths that occurred, 64% were linked to pheochromocytoma.

    Article  PubMed  CAS  Google Scholar 

  30. Frank-Raue K, Kratt T, Hoppner W, et al.: Diagnosis and management of pheochromocytomas in patients with multiple endocrine neoplasia type 2—relevance of specific mutations in the RET proto-oncogene. Eur J Endocrinol 1996, 135:222–225.

    Article  PubMed  CAS  Google Scholar 

  31. Lenders JW, Keiser HR, Goldstein DS, et al.: Plasma metanephrines in the diagnosis of pheochromocytoma. Ann Intern Med 1995, 123:101–109.

    PubMed  CAS  Google Scholar 

  32. Wocial B, Januszewicz W, Gryglas P, et al.: Evaluation of the usefulness for measuring catecholamines and their principle metabolites in the diagnosis of pheochromocytoma. Przegl Lek 1997, 54:793–798.

    PubMed  CAS  Google Scholar 

  33. Stridsberg M, Husebye ES: Chromogranin A and chromogranin B are sensitive circulating markers for pheochromocytoma. Eur J Endocrinol 1997, 136:67–73.

    Article  PubMed  CAS  Google Scholar 

  34. Sjoberg RJ, Simcic KJ, Kidd GS: The clonidine suppression test for pheochromocytoma. A review of its utility and pitfalls. Arch Intern Med 1992, 152:1193–1197.

    Article  PubMed  CAS  Google Scholar 

  35. Grossman E, Goldstein DS, Hoffman A, et al.: Glucagon and clonidine testing in the diagnosis of pheochromocytoma. Hypertension 1991, 17({db6 pt 1}):733–741.

    PubMed  CAS  Google Scholar 

  36. Jalil ND, Pattou FN, Combemale F, et al.: Effectiveness and limits of preoperative imaging studies for the localization of pheochromocytomas and paragangliomas: a review of 282 cases. Eur J Surg 1998, 164:23–28. These authors reviewed imaging studies in 282 patients with histologically confirmed pheochromocytoma to determine the optimal strategy for preoperative localization. Because of the accuracy of the studies, the authors question the routine use of the open abdominal approach, especially in patients with sporadic unilateral tumors.

    Article  PubMed  CAS  Google Scholar 

  37. Graham DJ, McHenry CR: The adrenal incidentaloma: guidelines for evaluation and recommendations for management. Surg Oncol Clin North Am 1998, 7:749–764.

    CAS  Google Scholar 

  38. Roizen MF, Hunt TK, Beaupre PN, et al.: The effect of alphaadrenergic blockade on cardiac performance and tissue oxygen delivery during excision of pheochromocytoma. Surgery 1983, 94:941–945.

    PubMed  CAS  Google Scholar 

  39. Boutros AR, Bravo EL, Zanettin G, et al.: Perioperative management of 63 patients with pheochromocytoma. Cleve Clin J Med 1990, 57:613–617.

    PubMed  CAS  Google Scholar 

  40. Perry RR, Keiser HR, Norton JA, et al.: Surgical management of pheochromocytoma with the use of metyrosine. Ann Surg 1990, 212:621–628.

    Article  PubMed  CAS  Google Scholar 

  41. Furino A, Massagli C, Pesce CV, et al.: Clinical experience with alpha blockers and calcium antagonists in the perioperative treatment of pheochromocytoma. Minerva Anestesiol 1994, 60:719–723.

    PubMed  CAS  Google Scholar 

  42. Colson P, Ryckwaert F, Ribstein J, et al.: Hemodynamic heterogeneity and treatment with the calcium channel blocker nicardipine during pheochromocytoma surgery Acta Anaesthesiol Scand 1998, 42:1114–1119.

    Article  PubMed  CAS  Google Scholar 

  43. Fernandez-Cruz L, Taura P, Saenz A, et al.: Laparoscopic approach to pheochromocytoma: hemodynamic changes and catecholamine secretion. World J Surg 1996, 20:762–768.

    Article  PubMed  CAS  Google Scholar 

  44. Joris JL, Hamoir EE, Hartstein GM, et al.: Hemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma. Anesth Analg 1999, 88:16–21.

    Article  PubMed  CAS  Google Scholar 

  45. Gagner M, Breton G, Pharand D, et al.: Is laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery 1996, 120:1076–1080.

    Article  PubMed  CAS  Google Scholar 

  46. Gagner M, Pomp A, Heniford BT, et al.: Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 1997, 226:238–247.

    Article  PubMed  CAS  Google Scholar 

  47. Godellas CV, Prinz RA: Surgical approach to adrenal neoplasms: laparoscopic versus open adrenalectomy. Surg Oncol Clin North Am 1998, 7:807–817. This paper discusses the indications for and disadvantages of various surgical approaches to adrenal neoplasms. It also addresses preoperative preparation and intraoperative care for patients with these neoplasms.

    CAS  Google Scholar 

  48. Remine WH, Chong GC, Van Heerden JA, et al.: Current management of pheochromocytoma. Ann Surg 1974, 179:740–748.

    Article  PubMed  CAS  Google Scholar 

  49. Mahoney EM, Harrison JH: Malignant pheochromocytoma: clinical course and treatment. J Urol 1977, 118:225–229.

    PubMed  CAS  Google Scholar 

  50. Pommier RF, Vetto JT, Billingsly K, et al.: Comparison of adrenal and extra-adrenal pheochromocytomas. Surgery 1993, 114:1160–1166.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Kentucky Medical Center, 800 Rose Street, 40515, Lexington, KY, USA

    Nader N. Hanna MD & Daniel E. Kenady MD

Authors
  1. Nader N. Hanna MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel E. Kenady MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hanna, N.N., Kenady, D.E. Hypertension in patients with pheochromocytoma. Curr Hypertens Rep 1, 540–545 (1999). https://doi.org/10.1007/s11906-996-0027-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-996-0027-6

Keywords

Search

Navigation