DR Medhat MRCP

o Signs (=features of sympathetic overactivity) :
1. Tachycardia , sweating ,pallor.
2. Sustained or episodic hypertension.
3. Postural hypotension in 50% of cases (intravascular depletion due to
prolonged HTN).
Investigations :
سؤال مهم جدا choice): 1) 24 hrs urinary catecholamines ( the test of
- Urinary catecholamines metabolites eg urinary metanephrins &
vanillymandelic acid (VMA) may be used in some centers but it`s less
sensitive (high false –ve rate) [so, don`t chose it in the exam.]
2) Plasma catecholamines & plasma metanephrins.
3) Ct/MRI abdomen (to localize the tumor)
4) Positron emission tomography (PET)scan (more sensetive in localising tumor).
5) Genetic screening of phaeochromocytoma.
سؤال Treatment :→ α-blockers then→ β-blockers if required then→ surgery
Surgery is the definitive management.
The patient must be pre-stabilized with medical management before surgery.
PHEochromocytoma - give PHEnoxybenzamine before beta-blockers
1) Alpha-blocker (e.g. phenoxybenzamine)
- Must be given 1 st before BB since there is a risk of life-threatening
hypertesive crisis due to unopposed α-adrenoreceptor activity.
2) Beta blocker (e.g propranolol).
• Prognosis : 5 years survival rate is→ 95% in benign pheochromocytoma.
40% in malignant pheochromocytoma.
سؤال مهم فى االمتحان Hypokalemia and Hypertension
Hypokalemia with HTN
1. Cushing's syndrome
2. Conn's syndrome .
3. Liddle's syndrome
4. 11-β-hydroxylase deficiency
5. Carbenoxolone (anti-ulcer drug)
6. High liquorice intake
Hypokalemia without HTN
1. Diuretics
2. GI loss (e.g. diarrhea, vomiting)
3. Renal tubular acidosis (type 1 and 2)
4. Gitelman syndrome
5. Bartter's syndrome