Causes of hypotension in pheochromocytoma

Written by Chen Yu Fei
Neurosurgery
Updated on September 16, 2024
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For cases of hypotension occurring in pheochromocytoma, it is most commonly seen after the surgical removal of the tumor. At this point, the concentration of catecholamines in the blood may significantly decrease, leading to a marked reduction in effective circulating blood volume, and thus causing hypotension. This situation is relatively common after surgery for pheochromocytoma. Usually, after surgical treatment and removal of the tumor, it is important to promptly discontinue the use of receptor blockers in patients and to appropriately replenish blood volume to effectively maintain central venous pressure. This approach can generally counteract the reduction in catecholamine levels caused by surgery, which leads to hypotension.

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Written by Li Lang Bo
Endocrinology
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What should I do if pheochromocytoma causes excessive sweating?

Patients with pheochromocytoma generally exhibit profuse sweating, which is a manifestation of sympathetic excitement. This occurs because the capillary beds throughout the body of a person with pheochromocytoma are constricted, including the sweat glands. Thus, it is easy to exhibit these symptoms of sympathetic excitement, characterized by nervousness, heavy sweating, and weight loss. So, how should this be treated? The key is to treat the cause. In the clinic, after collecting some blood history, conducting various blood tests, and performing adrenal CT scans among other imaging studies, a clear diagnosis of pheochromocytoma is made. Then, we will use some alpha receptor blockers, one to lower the blood pressure to a normal range and another to dilate the capillary beds throughout the body. After this, we proceed with the related surgical treatment. Following the surgical removal of the tumor, symptoms such as sweating will gradually be relieved.

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Written by Gan Jun
Endocrinology
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What should I do if a pheochromocytoma ruptures?

When a pheochromocytoma ruptures, it is advised that the patient immediately goes to the emergency department of the hospital for relevant examinations to confirm the diagnosis and to immediately control the blood pressure to a relatively stable and safe level. After a comprehensive evaluation, the urology department will perform emergency surgical removal to save the patient's life. Spontaneous rupture and bleeding of adrenal pheochromocytoma is quite rare. The possible reasons might be long-term hypertension leading to poor vascular function, or rapid tumor growth with high capsule pressure causing vascular rupture. Additionally, intense exercise, excessive fatigue, and transient increases in blood pressure could also be triggering factors.

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Written by Chen Yu Fei
Neurosurgery
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What tests are used for pheochromocytoma?

For pheochromocytoma, it is usual to perform both qualitative and localization diagnoses. The qualitative diagnosis is generally based on the measurement of catecholamines and their metabolites in the patient's blood and urine. Localization diagnosis is more commonly determined through methods such as CT scans, MRI, and ultrasound to pinpoint the specific location of the pheochromocytoma, facilitating surgical treatment. Most patients achieve satisfactory results from surgery. Additionally, treatment may include the use of antihypertensive drugs. With combined treatment, most patients can achieve satisfactory results. It is recommended to seek treatment at a well-known tertiary hospital locally.

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Written by Chen Yu Fei
Neurosurgery
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Pheochromocytoma clinical manifestations

Pheochromocytoma typically presents with severe hypertension, with blood pressure even reaching above 200/140 mmHg, accompanied by significant discomfort, such as profuse sweating, chest pain, obvious difficulty in breathing, chest tightness, shortness of breath, and other clinical manifestations. Moreover, if not treated timely and effectively, it can even lead to a hypertensive crisis. It also poses a severe threat to the patient’s heart, kidneys, liver, and brain tissues. Some patients might develop cerebrovascular diseases due to very high blood pressure, such as hypertensive cerebral hemorrhage, which can threaten the patient's life.

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Written by Chen Yu Fei
Neurosurgery
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Pheochromocytoma Test Items

For pheochromocytoma, the usual tests include routine blood tests, routine urine tests, and biochemical examinations. Specific tests mainly involve collecting blood and urine catecholamine metabolites to help diagnose the condition. Furthermore, further localization diagnostics are conducted on the patient via abdominal ultrasound, as well as CT or MRI scans, to determine the specific location of the pheochromocytoma growth. Further examinations are conducted in preparation for subsequent surgery, with treatment generally recommended to be surgical. During treatment, antihypertensive drugs are used in conjunction to control blood pressure and maintain stability of the condition.